Application Form For ROC (Taiwan) Ministry of Education Huayu Enrichment Scholarship
Application Form For ROC (Taiwan) Ministry of Education Huayu Enrichment Scholarship
1. PERSONAL DATA
a.NAME
Given Name(s)
Please attach a
photograph that has been
taken within the last 3
months.
Chinese Name
Title Mr./Mrs./Ms.
SurnameLast name
b. CITY and
COUNTRY OF
BIRTH
c. NATIONALITY
d. CONTACT
INFORMATION
e. SEX
Permanent Address
Mailing Address (If different from above)
Telephone
Cell phone:
Male
Female
f. MARITAL STATUS
Single Married
g. DATE OF BIRTH
(DayMonth Year ):
h. PAST
RESIDENCE in
TAIWAN
(dd/mm/yr) to
(dd/mm/yr);;
reason for staying in Taiwan:
1
i. Taiwan
Scholarship/
Huayu Enrichment
Scholarship Award
History/
(dd/mm/yr) to
(dd/mm/yr);
j. HEALTH
CONDITION
k. ANY CHRONIC
DISEASES
None
YesPlease specify
Relationship :
Name:
l. CONTACT
PERSON, IN
CASE OF AN
EMERGENCY
Address:
E-mail :
Tel:
2. LANGUAGE PROFICIENCY
LANGUAGE
PROFICIEN
CY
COMPREHENSION
READING
WRITING
SPEAKING
CHINESE
Excelle
nt
Good
Fair
Excellent
Good
Fair
Excellent
Good
Fair
Excellent
Good
Fair
ENGLISH
Other
(please state)
3. EDUCATIONAL BACKGROUND
Level
Name of Institution
Period of Enrollment
Country/City
Secondary
Education
Undergraduate Level Education
4. REFERENCES ()
Name
Position
Company/Organization
Period of Employment
Responsibilities
6. PRESENT EMPLOYMENT
a. COMPANY/
ORGANIZATION
c. From
b. POSITION
d. CONTACT
INFORMATION
Address
Tel
Cell phone:
Fax
e. TYPE OF ORGANIZATION
Institution
Govt./State-owned Agency
Enterprise
NGO Enterprise
7. LANGUAGE CENTER WHERE YOU PLAN TO ATTEND IN TAIWAN
University-affiliated language center:
9. DECLARATION:
I declare that: The information I have given on this application is complete and accurate to the best of my knowledge.
Applicants Signature
Date
_____ /_____/_____