(2017)

(2017)
Application Form For Taiwan Scholarship 2017
Ministry of Education, Republic of China (Taiwan)
INSTRUCTIONS:
This application form should be typed 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
Doctor Scholarship

1. PERSONAL DATA

1).NAME Title Mr./Mrs./Ms. Please attach a recent

SurnameLast name photograph taken within the

last 3 months.
Given Name(s)

Chinese Name

(Una foto reciente del

tamao carn).
2). CITY and COUNTRY
OF BIRTH .

3). 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 MOTHER

4). PARENTS Name : Name :

INFORMATION Nationality : Nationality :
Place of Birth : Place of Birth :

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5). CONTACT
INFORMATION Permanent Address

Mailing Address (If different from above)

Telephone E-mail

Cell phone :

6). SEX Male Female

7). MARITAL STATUS
Single Married
8). DATE of BIRTH (Day Month Year ):

9). PAST RESIDENCE Never ; Yes, from (dd/mm/yr) to (dd/mm/yr).
in TAIWAN
reason for residence :

10). Taiwan Scholarship/
Huayu Enrichment
None ; Yes, from (dd/mm/yr) to (dd/mm/yr);

Scholarship Award
Type(s) of Scholarship Awarded:
History
/

11). HEALTH CONDITION

Excellent Good Fair

12). CHRONIC DISEASES

None

Yes Please specify

13). CONTACT PERSON,

Name : Relationship :
IN CASE OF AN
EMERGENCY
Address :

Telephone : E-mail :

Cell phone :

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2. LANGUAGE PROFICIENCY

COMPREHENSION
LANGUAGE READING WRITING SPEAKING

PROFICIENCY
Excellent Good Fair Excellent Good Fair Excellent Good Fair Excellent Good Fair

CHINESE

ENGLISH

(Other)

(Other)

3. EDUCATIONAL BACKGROUND
Name of Institution Country & Place Period of Enrollment
Level

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)

Company/Organization Period of Employment Responsibilities

Position

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6. PRESENT EMPLOYMENT

1).
COMPANY/
ORGANIZATION

2). POSITION
3). From

Address
4). CONTACT
INFORMATION Telephone Cell phone :

Fax E-mail

Govt. Ministry/ University/ Govt./State-owned

5). TYPE OF Agency Institution Enterprise
ORGANIZATION
Locally-owned Joint Venture International NGO
Enterprise Enterprise

6). PRESENT
DUTIES &
YEARS OF
EMPLOYMENT

7. UNIVERSITY/DEPARTMENT WHICH YOU PLAN TO ATTEND IN TAIWAN

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University/college and department:

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8. PLEASE BRIEFLY STATE YOUR STUDY PLAN WHILE IN TAIWAN
(If necessary, additional pages of the same size may be attached. )

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

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_____ /_____/_____

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