大仁科技大學外國籍學生獎助學金申請表TajenUniversityForeignStudentScholarshipApplicationFormPleasecompleteinEnglishexceptwhereaskedtouseChinese.1.Name姓名:(inEnglish):Name姓名::(inChinese):Title抬頭:2.Sex姓別:3.MaritalStatus婚姻狀況:4.Nationality國籍:5.DateofBirth生日:6.Contactaddress聯絡住址:(inChinese)………………………………………………………………………………………………………………7.Contactaddress聯絡住址:(inEnglish)………………………………………………………………………………………………………………Tel(H):…………………………..(O):…………………………Fax/Email:…………………….………………………………….8.EducationBackground(PleaseenclosecertifiedChineseorEnglishtranslationsofyourtranscripts.)教育背景(請附上中文或英文之在學成績單)Institution學校From(d/m/y)To(d/m/y)Major主修QualificationObtained學歷9.EmploymentBackground就業背景PleaseprovidedetailsofpastandcurrentworkexperienceEmployerFrom(d/m/y)To(d/m/y)Position&NatureofDuties10.AdditionalInformation其他個人資訊(Pleaseprovideinformationaboutthereasonsforchoosingyourareaofstudyorresearch,anyrelevantworkexperience;andyourintendedfuturecareer.)11.ChineseLanguageProficiency中文程度PleaseprovideevidenceofyourChineseLanguageability.TowhatextentdoyouuseChineseinyourworkorinyourstudies?12.UniversitiesApplied其他已申請之學校（請列出您已申請之學校及系所）(Pleasegivedetails,inorderofpreference,oftheuniversitiesandcoursesforwhichyouhaveapplied)InstitutionName學校名稱CourseName系所名稱TypeofQualification(e.g.BS,MA,MSc,)學位Currentstatusofapplication*申請狀況1.2.3.4.5.*Ifyouhavenotreceivedanofferyet,pleasewriteNO*Ifyouhavebeenawardedanunconditionaloffer,pleasewriteUCO*Ifyouhavebeenawardedaconditionaloffer,pleasewriteCO(Pleaseencloseacopyofyourletterofoffer)13.DateAvailableforStudyinTaiwan,ROC?….….day…….month…….year何時可在臺灣就讀?14.Referees推薦人(Pleaseasktwopeopletoprovidewrittenreferencesonyourbehalf,usingthestandardform.Pleasecopythestandardformifyouneedmorecopies.)Referee1Referee2NameNameOccupationOccupationAddressAddressTelephoneTelephone15.Declaration聲明IcertifythatIamnormallyresidentinandthat,tothebestofmybelief,thestatementsmadeinthisapplicationaretrue.IhavereadandunderstoodtheScholarshipRegulations.Signature:Date:請填妥申請書連同其他文件，於6月30日前郵寄至以下地址：Pleasesendyourcompletedapplicationform,togetherwithalldossiers,totheOfficeofAcademicAffairsattheaddressbelowtoarrivenolaterthanJune30,2006:CenterofInternationalCooperationTajenUniversityNo.20,Wei-ShinRd.,Shin-ErTsun,Yan-PuHsiang,Pingtung907,Taiwan
