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科科科科科科科科科科科 APPLICATION FORM FOR MOST TAIWAN SCHOLARSHIP INSTRUCTIONS: This application form should be typed and completed by the applicant Each question must be answered clearly and completely Detailed answers are required in order to make the most appropriate arrangements If necessary, additional pages of the same size may be attached 科科科科科科科科科科科科科科科科科科科科科科科科科科科科科科科科 科科科科科科科科科科科科科科 Please check 科科科科科科 Which type of scholarship are you applying for? □ Master Scholarship 科科科科科 □ Doctoral Scholarship 科科科科科 PERSONAL DATA 科科科科科科 a.NAME 科科 Title 科科科 Mr./Mrs./Ms Please Surname科Last name科科科 photograph taken within the attach a last months Given Name(s) 科科 科科科科科科科 b CITY and COUNTRY OF BIRTH 科科.科科科科科 c NATIONALITY 科科 *Note: If one or both of your parents was an ROC national at the time of your birth, you are an ROC national as well and therefore not eligible to apply FATHER 科 d PARENTS’ MOTHER 科 INFORMATION 科科科科 Name 科科: Name 科科: Nationality 科科: Nationality 科科: Place of Birth 科科科: Place of Birth 科科科: -1- recent e CONTACT INFORMATION 科科科科科科科科科科科科 Permanent Address 科科科科科 Mailing Address (If different from above)科科科科科 Telephone 科科科 E-mail 科科科科科 Cell phone 科科: f SEX 科科 g MARITAL STATUS □ Male 科 □ Female 科 科科科科 □ Single 科科 □ Married 科科 h DATE of BIRTH (Day 科科Month 科科Year 科): 科科 i PAST RESIDENCE in TAIWAN 科科科科 j TAIWAN □Never 科; □Yes, from (dd/mm/yr) to (dd/mm/yr).科科科科科科 reason for residence 科科科科: □None 科; □Yes, from SCHOLARSHIP/ (dd/mm/yr) to Type(s) of Scholarship Awarded: HUAYU ENRICHMENT SCHOLARSHIP AWARD HISTORY 科科科 科科/科科科科科科科科科科 k HEALTH CONDITION 科科科科 l CHRONIC DISEASES □ Excellent □ Good □ Fair □ None 科 科科科 □ m CONTACT PERSON, Yes 科─Please specify 科科科科 Name 科科: Relationship 科科: IN CASE OF AN EMERGENCY 科科科科科科科 (dd/mm/yr);科科科科科科 Address 科科: Telephone 科科: E-mail 科科科科: Cell phone 科科: -2- LANGUAGE PROFICIENCY 科科科科 LANGUAGE COMPREHENSION READING WRITING SPEAKING PROFICIENCY 科 科 科 科 科科科科 Excellent Good Fair Excellent 科 科 科 科 Good 科 Fair 科 Excellent Good 科 Fair 科 Excellent 科 Good 科 科 Fair 科 CHINESE ENGLISH (Other, please state) EDUCATION AND TRAINING 科科科科 Note: Highest Diploma Only School Name Subject Qualification Country & Place Year Obtained 科科科科 科科科科 (Certificate / Diploma 科科 科科科科科科 / Degree) 科科 REFERENCES 科科科科 (科) 科科 Name 科科 Position 科科 Telephone , E-Mail or Mailing Address 科科科科科科科 EMPLOYMENT / JOB EXPERIENCE (Use one line for each position) 科科科科 Position Company/Organization Period of Employment Responsibilities 科科 科科科科 科科科科 科科科科 -3- -4- UNIVERSITY/DEPARTMENT WHICH YOU PLAN TO ATTEND IN TAIWAN 科科科科科科 科科科科 University/college and department: -5- RECOMMENDATIONS OF NATIONAL AUTHORITY / INSTITUTE 科科科科 / INTERNATIONAL SELECTING Comments on applicant: Responsible Official: Title _ Signature: Name: _ Date: _ -6- PLEASE BRIEFLY STATE YOUR STUDY PLAN WHILE IN TAIWAN 科科科科科科科科科 -7- DECLARATION: I declare that: □ The information as provided by me in this document is true and accurate I understand and accept that any false declaration of information on my part will disqualify me from the program, even when it is in progress □ I am not suffering from any serious disease and that I am not hindered in the performance of my duties by any illness or disability □ I am neither concurrently an ROC national, nor an overseas compatriot of the ROC □ I am not currently undertaking studies in Taiwan for the same educational level as the scholarship type for which I am applying □ I am not applying for this scholarship as an exchange student resulting from an agreement signed between my home institution and any Taiwan university/college □ I consent that the information that I provided in this application form can be shared among R.O.C.’s government agencies and non-government agencies for scholarship related matters once I become a recipient of Taiwan Scholarship Applicant’s Signature Date _ 科 _ 科 _ Day 科科Month 科科Year 科 -8- ... E-Mail or Mailing Address 科科科科科科科 EMPLOYMENT / JOB EXPERIENCE (Use one line for each position) 科科科科 Position Company/Organization Period of Employment Responsibilities 科科 科科科科 科科科科 科科科科 -3 - -4 -. .. _ Signature: Name: _ Date: _ -6 - PLEASE BRIEFLY STATE YOUR STUDY PLAN WHILE IN TAIWAN 科科科科科科科科科 -7 - DECLARATION: I declare that: □ The information as provided... Responsibilities 科科 科科科科 科科科科 科科科科 -3 - -4 - UNIVERSITY/DEPARTMENT WHICH YOU PLAN TO ATTEND IN TAIWAN 科科科科科科 科科科科 University/college and department: -5 - RECOMMENDATIONS OF NATIONAL AUTHORITY /