Professional Documents
Culture Documents
Permanent Address
Mailing Address (If different from above)
Telephone E-mail
Cell phone :
f.
SEX Male Female
g.
MARITAL STATUS
Single Married
h.
DATE of BIRTH
(Day Month Year ):
i. PAST RESIDENCE in
TAIWAN
Never ; Yes, from (dd/mm/yr) to (dd/mm/yr).
reason for residence :
j. Taiwan Scholarship/
Huayu Enrichment
Scholarship Award
History /
None ; Yes, from (dd/mm/yr) to (dd/mm/yr);
Type(s) of Scholarship Awarded:
k.
HEALTH CONDITION
Excellent Good Fair
l
CHRONIC DISEASES
None
Yes Please specify
m.
CONTACT PERSON,
IN CASE OF AN
EMERGENCY
Name : Relationship :
Address :
Telephone : E-mail :
Cell phone :
- 3 -
2. LANGUAGE PROFICIENCY
LANGUAGE
PROFICIENCY
COMPREHENSION
READING WRITING SPEAKING
Excellent
Good
Fair
Excellent
Good
Fair
Excellent
Good
Fair
Excellent
Good
Fair
CHINESE
ENGLISH
(Other, please state)
3. EDUCATIONAL BACKGROUND
Level
Name of Institution
Country &City
Period of Enrollment
Secondary
Education
Undergraduate Level
Education
Graduate Level
Education
4. REFERENCES ()
Name
Position Telephone , E-Mail or Mailing Address
5. PREVIOUS EMPLOYMENT (Use one line for each position)
Position
Company/Organization
Period of Employment
Responsibilities
- 4 -
6. PRESENT EMPLOYMENT
a
.
COMPANY/
ORGANIZATION
b
.
POSITION
c. From
d. CONTACT
INFORMATION
Address
Telephone Cell phone :
Fax E-mail
e. TYPE OF
ORGANIZATION
Govt. Ministry/ University/ Govt./State-owned
Agency Institution Enterprise
Locally-owned Joint Venture International NGO
Enterprise Enterprise
f. PRESENT
DUTIES &
YEARS OF
EMPLOYMENT
7. UNIVERSITY/DEPARTMENT, YOU PLAN TO ATTEND IN TAIWAN
University/college and department:
- 5 -
8. PLEASE BRIEFLY STATE YOUR STUDY PLAN WHILE IN TAIWAN
9. 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.
Applicants Signature
Date
_____ /_____/_____