(For official use only)

Application No.

Form A (For
new

( )
APPLICATION FORM FOR A TAIWAN SCHOLARSHIP(Sample)
INSTRUCTIONS:

This application form should be typed in English or Chinese and completed by the
applicant. Each question must be answered clearly and completely. Detailed answers
are required in order to make the most appropriate arrangements. If necessary,
additional pages of the same size may be attached.

Please check.
Which type of scholarship are you applying for?
Undergraduate Scholarship
Master Scholarship
Doctoral Scholarship
Do you need to attend a Chinese Language Enrichment Program (The LEP program must

be undertaken during the first year)?

Yes
No (If yes, please fill in the name of the
language center for item 7 on page 4 and apply for admissions to a degree program for the 2011
academic year.)
1. PERSONAL DATA
a.NAME (Please
make sure same as in
Passport )

Title Mr./Mrs./Ms.

Please

SurnameLast name

photograph taken within the

attach

recent

last 3 months.

Given Name(s)

Chinese Name
b. CITY and COUNTRY OF
BIRTH .

c. NATIONALITY

*Note: If one or both of your parents was an ROC national at the time of your birth,
you are an ROC national as well and therefore not eligible to apply.

FATHER

d. PARENTS

MOTHER

INFORMATION

Name :

Name :

Nationality :

Nationality :

Place of Birth :

Place of Birth :

e. CONTACT
INFORMATION

f. SEX

g. MARITAL STATUS

Permanent Address
Mailing Address (If different from above)
Telephone

E-mail

Cell phone :

Male Female

Single Married

h. DATE of BIRTH

(Day Month Year ):

i. PAST RESIDENCE in

TAIWAN
j. Taiwan Scholarship/

Never ; Yes, from

(dd/mm/yr) to
(dd/mm/yr).
reason for residence :

None ; Yes, from

Huayu Enrichment

(dd/mm/yr) to

(dd/mm/yr);

Type(s) of Scholarship Awarded:

Scholarship Award
History /
k. HEALTH CONDITION

l CHRONIC DISEASES

Excellent Good
None

m. CONTACT PERSON,

IN CASE OF AN

Fair

Yes Please specify

Name :

Relationship :

Address :

EMERGENCY
Telephone :

Cell phone :

2. LANGUAGE PROFICIENCY

E-mail :

LANGUAGE

READING

COMPREHENSION

PROFICIENCY

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

6. PRESENT EMPLOYMENT

a. COMPANY/
ORGANIZATION

c. From

b. POSITION

d. CONTACT
INFORMATION

Address
Telephone

Fax

e. TYPE OF
ORGANIZATION

Govt. Ministry/
Agency

Locally-owned
Enterprise

Cell phone :
E-mail

University/

Govt./State-owned

Institution

Enterprise

Joint Venture International

NGO

Enterprise

f. PRESENT
DUTIES &
YEARS OF
EMPLOYMENT

7. LANGUAGE CENTER OR/AND UNIVERSITY/DEPARTMENT, WHICH YOU

PLAN TO ATTEND IN TAIWAN
University affiliated language center:

University/college and department:

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.

10. CHECK LIST

Application Form.
A copy of the applicants passport or other nationality certificates.
A copy of the highest degree and academic transcripts.
A copy of admission application materials to universities/colleges in Taiwan

 A copy of a language proficiency certificate:

1. A copy of results or certificate for the Test of Chinese as a Foreign Language (TOCFL) Level3 or
above.
2. For applications to all-English programs, a copy of TOEFL test scores or other recognized English
language proficiency exams or degrees awarded in English must be submitted. English-speaking
nationals are exempt from this rule.
Two letters of reference signed and sealed in envelopes (i.e. from the principals, professors, or
supervisors). Photo copies and email submissions of letters of recommendation will not be considered.
Additional documents as specified by the individual representative offices.

Applicants Signature

Date

_____ /_____/_____