Taiwan Shoufu University

Chinese Language Center

Application Form
No.168,Nanshi Li, Madou Dist., Tainan City, Taiwan
http://www.tsu.edu.tw/
Please fill out the form and send it with the rest of the application materials to
the address above.
Name Date of Birth 19 Dicember 1998

Last Cubas Nationality Nicaraguan

First Walter Passport No. C02164187
Middle Ivan Gender □ Female ✓Male
Present
Chinese name 古嶽弘 Student
Occupation
Mailing Address
Permanent Address
(Complete if different from permanent address)

No. and Street San Miguel

City(Province, State) Boaco,Boaco
Postal(Zip) Code 51000
Country Nicaragua
Tel. +505 25421572
Fax.

Email Waltercubas100@gmail.com
Emergency Contact Address Boaco, Nicaragua, san Miguel área from pali 2 ½ blocks north
Educational Background (Current Educational Level)
School Name National Public Institute of Boaco
City and Country Boaco,Nicaragua
Degree (Date) Year 2014 Month Dicember

Major High school

Minor (if applicable)

How will you finance the major portion of your studies at the Center？
□　Personal Savings　　　 ✓ Scholarship （o___Mofa__________________）
（of_________________________________） awarded by：Mofa scholarship granted by the Taiwanese
government.
□ Parental Support　　　
_______________________________________（of_________________________________） . □ Other (specify)：
____________________
Which period of study are you applying for？
For the autumn period at the beginning of September

 (9 月- 1 月) Winter Session (Sep. - Jan.) Period Preferences

□Basic ✓Novice□ Intermediate□ Advanced
✓ 8:10-10:00
 (2 月- 6 月) Spring Session (Feb.- Jun.)
✓10:10-12:00
□Basic □Novice □ Intermediate□ Advanced
□13:10-15:00
 (7 月- 8 月) Summer Session (Jul.- Aug.)
□15:10-17:00
□Basic□ Novice□ Intermediate□ Advanced
 customized Class
□Basic□Novice□Intermediate□Advanced
Class assignment will be based on your 1)8:10 -10:00

result of the placement test. 2)10:10-12:00

Have you learned Chinese before ？　　　□Yes ✓ No

If yes, complete the following section：
1.When ？_____________________________
State years, months studied. ____ year(s) ____month(s)
How many hours per week？ ________hours/week
Where did you study？___________________________________ □Self-study
2. Which have you studied？
□Simplified Characters □Traditional Characters □zhuyin (ㄅㄆㄇㄈ) □Modern Chinese
□Literary Chinese □Pinyin
□Listening Comprehension □Speaking □Reading □Writing
3.Do you regularly use Chinese in your home country ？ □ Yes □ at home □
at work ✓No
□ How many hours a day？
4.Have you ever lived in a Chinese-speaking country?
□Yes □Which country？ _______________________________ ✓ No
□When？___________________ □How long？_________________
5.Have you ever taken a Chinese Proficiency test？
□ Yes How were you placed？ ✓ No
□Beginner □Intermediate □Advanced
6.List the main books you have formally
studied (please indicate title and level)
Applicant’s Signature Date 07/03/2017