附錄三

112學年度崑山科技大學國際學生秋季班入學申請表
Kun Shan University
Special Programs Application for International Students
Fall Semester 2023 此處貼最近 6 個
月內二吋半身
脫帽照片
□新南向產學合作國際專班 A 2-inch photo taken
International Programs of Industry-Academia Collaboration in the last 6 months
for students from New Southbound. must be attached to the
※Period of Study: September, 2023 – June, 2027 form.
All answers must be machine written (typewriter or computer). (size 4*6)
Incomplete applications will not be considered.

1、申請人資料 Personal Information:

英文姓名 English Name:

(First) (Middle) (Last)
(須與護照姓名相同 Please fill out full name as appeared in the passport.)
中文姓名 Chinese Name:
生理性別 Sex: □男 Male □ 女 Female 婚姻狀況 Marital status: □單身 Single □已婚 Married
國籍 Nationality: 生日 Date of Birth: / /
護照號碼 Passport No.: (month) (day) (year)
護照有效期限 Passport Expiry Date:
居住地址 Mailing Address:
聯絡電話 Telephone:
電子郵件 E-mail: (i.e.+886(Taiwan country code)-6(district code)-Number)
手機號碼Cell Phone:
第一監護人姓名 Legal Guardian 1’s name (姓 Last Name / 名 First Name):
手機號碼 Cell Phone: 國籍 Nationality:
第二監護人姓名 Legal Guardian 2’s name (姓 Last Name / 名 First Name):
手機號碼 Cell Phone: 國籍 Nationality:
家庭狀況 Family:
□與監護人同住 living with Guardian □與單親同住 living with a parent □其他 others
家庭成員 Members of family: 兄弟姊妹人數 Numbers of sibling 人 persons
2、學歷 Educational Background
中學 學院或大學
學位 Degree
Secondary School College/ Undergraduate
學校名稱 Name of School
國家 City and Country
修業起訖年月 Academic term
主修 Major