Application Form for ROC (Taiwan)
Taiwan Scholarship
Please attach a
photograph that
has been taken
within the last 3
months.
This application form should be TYPED and completed by the applicant.
If necessary, additional pages of the same size may be attached .
Which type of scholarship would you like to apply for?
□ Master Scholarship □ Doctoral Scholarship
University/Department plan to attend: _________________________________________
Do you need to attend a Chinese Language Enrichment Program (The LEP must be
undertaken during the first year)?
□ Yes, University affiliated language center plan to attend: ____________________________
(Please apply for admissions to a degree program for the 2011 academic year.)
□ No.
1. PERSONAL DATA
NAME
(Last name)
(Given Name)
(Chinese Name, if applicable)
FATHER’S NAME
(Last name)
(Given Name)
(Chinese Name, if applicable)
MOTHER’S NAME
(Last name)
(Given Name)
(Chinese Name, if applicable)
Note: If one or both of your parents were an ROC national at the time of your
birth, you are an ROC national as well and therefore not eligible to apply.
NATIONALITY
□Single
□Married
(dd/mm/yy)
DATE OF BIRTH
□Female □Male
AGE
PAST RESIDENCE IN TAIWAN
PLACE OF BIRTH
□Never □Yes, from (dd/mm/yy) to (dd/mm/yy)
CONTACT
Reason for residence:
Address:
Tel.:
Mobile:
Fax:
Email:
INFORMATION
HEALTH CONDITION
ANY CHRONIC
DISEASES
CONTACT PERSON,
IN CASE OF
EMERGENCY
□ Excellent □ Good □ Fair
□None □ Yes. If yes, Please specify.
Name:
Relationship:
Tel.:
Mobile:
Email:
Address:
2. LANGUAGE PROFICIENCY
LANGUAGE
PROFICIENCY
COMPREHENSION
Excellent
Good
Fair
READING
Excellent
Good
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WRITING
Fair
Excellent
Good
SPEAKING
Fair
Excellent
Good
Fair
CHINESE
ENGLISH
3. EDUCATIONAL BACKGROUND
Level
Degree
Name of Institution
Country/City
Major
Period of
Enrollment
Secondary Education
Undergraduate Level
Education
Graduate Level Education
4. EMPLOYMENT RECORD
Experience
Previous
Previous
Present
Position
Company/Organization
Employment Period
5. REFERENCES
Name
Position
Company
Phone, Mobil, Email, Address
6. PLEASE BRIEFLY STATE YOUR STUDY PLAN WHILE IN TAIWAN
7. DECLARATION: I declare that:
□
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;
□
The information I have given on this application is complete and accurate to the best of my knowledge.
Applicant’s Signature
Date
_____ /_____/_____
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