Attachment 1
I-SHOU UNIVERSITY
APPLICATION FORM FOR THE SCHOOL OF MEDICINE FOR
INTERNATIONAL STUDENTS
Attach a recent
original photo
here
I-Shou University
No.8, Yida Rd., Jiaosu Village, Yanchao District,
Kaohsiung City 82445, Taiwan R.O.C.
2013
Fall Semester (Beginning in September)
Department/ Department/Institute: School of Medicine for International Students
Institute
Program taught in English
Personal Information
dd
Applicant’s
Full Name
(English)
Date of Birth
(Chinese)
Gender
mm
yyyy
□ Male
□ Female
Address
Mailing
Address
E-mail
(Required)
Telephone
+Country-Code-Number
Mobile
+Country-Number
Does your home country have
diplomatic relations with Taiwan?
Place of Birth
Yes, my
home
country is:
No, my
home
country is:
(please specify)
(1)
(2) If any
Full Name: (Chinese or English)
Full Name: (Chinese or English)
Nationality:
Nationality:
Father
Mother
Place of Birth:
□Never possessed Chinese nationality.
Telephone:
Full Name: (Chinese or English)
Contact in
Taiwan
Passport No.
Mailing Address in Taiwan:
Place of Birth:
□Never possessed Chinese nationality .
Telephone:
Relationship:
Telephone:
Educational Background
Name of Institution
University/
Duration of Study
College
(mm/yyyy)
From:
To:
Degree
Country
GPA/Highest
Possible Grade
Major
/
Name of Institution
Graduate
Duration of Study
School
(mm/yyyy)
From:
To:
Degree
Country
GPA/Highest
Possible Grade
Major
Financial Supports: What is your major financial resource while you are studying at ISU?
□ Others
□ Parental Support
(in NT$ or US$) (in NT$ or US$)
□ Personal Savings
(in NT$, or US$)
Are you applying for a scholarship?
□ No
□Yes (Please fill out the Taiwan ICDF Higher Education Scholarship Application Form)
Health Status
□ Good
□ Average
□ Poor
Please specify if you have any current health concerns:
How did you know about us?
□ Newspaper:
□ From an Organization:
□Internet Search
□ Magazines
□ Other:
□ From a Friend
/
Chinese Proficiency
□ I have never learned Chinese
□ From
to
How long have you learned Chinese?
If so, where did you learn Chinese?
(e.g. a high school, college or language institution)
Have you ever taken any Chinese proficiency
test?
□
□
Yes
No
Test Title
Score
Self-evaluation of Chinese Proficiency
Listening
□ Excellent
□ Good
□ Average
□ Poor
Speaking
□ Excellent
□ Good
□ Average
□ Poor
Reading
□ Excellent
□ Good
□ Average
□ Poor
Writing
□ Excellent
□ Good
□ Average
□ Poor
□ I cannot take courses taught in Chinese.
□ I can take courses taught in Chinese, but I shall take additional Chinese courses to improve my Chinese.
□ I can take courses taught in Chinese, and there is no need for me to take additional Chinese courses.
English Proficiency
□ I have never learned English
How long have you learned English?
□ From
to
Where did you learn English
(e.g. a high school, college or language institution)
Have you ever taken any English proficiency
□ Yes
test?
□ No
Test Title
Score
Self-evaluation of English Proficiency
Listening
□ Excellent
□ Good
□ Average
□ Poor
Speaking
□ Excellent
□ Good
□ Average
□ Poor
Reading
□ Excellent
□ Good
□ Average
□ Poor
Writing
□ Excellent
□ Good
□ Average
□ Poor
□ I cannot take courses taught in English.
□ I can take courses taught in English, but I shall take additional English courses to improve my English.
□ I can take courses taught in English, and there is no need for me to take additional English courses.
I-Shou University
Affidavit for the School of Medicine for International Students Application
I hereby authorize I-Shou University to verify the information provided below. If any deception, concealment, violation or forgery
is found, I have no objection to being disqualified from admission to ISU and my student status will be revoked, and no proof of
attendance or diploma will be issued.
Signature:
Date:
I hereby certify the information provided below
1.
Nationality and residence
I am neither an overseas compatriot student nor an R.O.C. national as defined in Article 2 of the Nationality Act*, and I never
possess a Chinese nationality or a citizenship of Hong Kong or Macau at the time of application.
2.
The highest degree submitted by me (a bachelor degree or above) is valid and has been awarded legally in the country where I
graduated. The diploma submitted by me is comparable to that awarded by accredited institutions in Taiwan.
3.
All the documents provided by me (including the application form, the diploma, passport and other relevant documents, original
or photocopy) are valid. Should any document be found to be invalid or false, my admission to ISU will be revoked, and no proof
of attendance will be issued.
4.
Once admitted, I must present the original of the diploma and transcripts officially authenticated by the R.O.C. overseas office or
representative office in the country where the school is located at the time of registration. If I fail to submit required documents or
any of the documents submitted does not meet the provisions of the Regulations Regarding the Assessment and Recognition of
Foreign Academic Credentials for Institutions of Higher Education of the Ministry of Education, R.O.C., ISU reserves the right
to disqualify me from being admitted to the University.
5.
The University shall handle applicants’ personal information pursuant to the Personal Information Protection Act enforced by the
R.O.C. government, and applicants’ personal information shall be used for student recruitment purposes and relevant statistical
analyses only. The personal information of enrolled students shall be used for student enrollment purposes only.
6.
Students shall return to their home countries after graduation and completing the clinical internship, and they are not
allowed to take the medical license examination or conduct medical practice in Taiwan.
＊Note：
According to Article 2 of the Nationality Act, a person shall have the nationality of the Republic of China under any of the conditions
provided by the following subparagraphs:
1. His/her father or mother was a national of the Republic of China when he/she was born.
2. He/she was born after the death of his/her father or mother, and his/her father or mother was a national of the Republic of
China at the time of death.
3. He/she was born in the territory of the Republic of China, and his/her parents can’t be ascertained or both were stateless
persons.
4. He/she has undergone the nationalization process.
Preceding Subparagraph 1 and Subparagraph 2 shall also apply to the persons who were minors at the time of the amendment and
promulgation of this Act.
Attachment 2
Academic Certificate Declaration
*Please submit the declaration, the application form and documents
for application review to the Admissions Section of the University via fax,
e-mail or uploading.
The academic certificate issued by ________________ as a BA/MA diploma
(or equivalent documents) is approved by the R.O.C. Ministry of Education.
The undersigned guarantees that the following authenticated diploma,
certificates, and/or the authenticated official complete transcript of record will
be handed over upon registration:
1. The copy of the certificate of a bachelor degree certified by a local R.O.C.
embassy, a local R.O.C. overseas office or a R.O.C. representative office
(A notarized Chinese translation shall be provided as well).
2. The original copy of the academic transcript certified by a local R.O.C.
embassy, a local R.O.C. overseas office or a R.O.C. representative office
(A notarized Chinese translation shall be provided as well).
If the related certificates cannot be submitted on time, or they are found to be
untrue or unacceptable in accordance with the Regulations Regarding the
Assessment and Recognition of Foreign Academic Credentials for Institutions
of Higher Education promulgated by the R.O.C. Ministry of Education, the
under-signee shall be denied admission.
State/Country of School
Where
Applicant
Graduated
Name of School and
Department
Where
Applicant Graduated (in
foreign language)
From
to
Period of Study
(YYYY/MM/DD)
(YYYY/MM/DD)
Department School of Medicine for
Applied
International Students
Signature of
Applicant
Contact
Home:
Number
Mobile:
Serial No.
(To be completed by the University)
Passport No.
Mailing
Address
D a t e :
M M
D D ,
2 0 1 3
I-Shou University
Attachment 3
Checklist of Documents
* Full name: (English)：
* Full name: (Chinese)：
Please check the items that you have submitted ()
check()

Documents Required for Application
Quantity
The following documents are required for all applicants:
An Application Form
1
A photocopy of the passport or the proof of nationality
1
A photocopy of the diploma in English or Chinese
1
An official transcript in English or Chinese
1
Certificate of completing at least 6 credits of courses relevant to biology, chemistry or
list sciences
English Proficiency Certificate
Test Title：
1
1
An autobiography in English
1
Letter of recommendation
3
Transcript of the medical school admission test (MCAT, BMAT or GAMSAT) taken within
3 years
1
Practical experiences in medical practice and laboratories
1
Volunteer service experiences
1
Other:
Other:
Other:
Note: Applicants must submit an original copy of the Health Report issued by a hospital (including HIV test
results, Measles and Rubella Antibody Positive Report or certification of prophylaxis inoculation;
please only use the form attached herewith) to the local R.O.C. embassy or the local R.O.C. overseas
office when applying for their student visa for entry to Taiwan, as well as to the Health Section of the
University at the time of registration.