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教育部華語文獎學金申請表
Application Form for
R.O.C. (Taiwan) Ministry of Education Huayu Enrichment Scholarship
2024
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
.
申請人請詳實工整填寫，慎勿遺漏，以利配合作業，如有需要，可自行以同款紙張加頁說明。
1. PERSONAL DATA 個人基本資料
a.NAME 姓名
영어이름 여권과
동일하게 기재
Title 稱謂： Mr./Mrs./Ms.
Surname（Last name）姓：
(
국문
)
/ (
영문
)
Given Name(s) 名：
(
국문
)
/ (
영문
)
Chinese Name 中文姓名：
Please attach a photograph that
has been taken within the last
3 months.
最近三個月相片
b. CITY and COUNTRY OF
BIRTH 出生城市及國別
c. NATIONALITY 國籍
*Note: If one or both of your parents were an ROC national at the time of your
birth, you are an ROC national as well and therefore not eligible to apply.
d. CONTACT
INFORMATION
聯絡地址、電話、電子
郵件
Permanent Address
永久地址：
(
국문 및 영문주소,우편번호)
Mailing Address (If different from above)郵寄地址：
(
국문 및 영문주소,우편번호)
Telephone
電話：
電子郵件：
*
반드시 연락 가능한 핸드폰 번호 및 이메일주소 기재 요망
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e. SEX 性別
□ Male 男 □ Female女
f. MARITAL STATUS
婚姻狀況
□ Single 單身 □ Married 已婚
g. DATE OF BIRTH
生日
(Day 日／Month 月／Year 年):
h.
PAST RESIDENCE
in TAIWAN
曾否居住台灣
□Never 否; □Yes, from (dd/mm/yr) to (dd/mm/yr);是，起迄日期;
reason of residence 居住事由:
i. Taiwan Scholarship/
Huayu Enrichment
Scholarship Award
History 臺灣獎學金
/華
□None 無; □Yes, from (dd/mm/yr) to (dd/mm/yr);是，起迄日期。
Type(s) of Scholarship Awarded:
j. HEALTH CONDITION
健康狀況
□ Excellent □ Good □ Fair
k. ANY CHRONIC
DISEASES 慢性病
□ None無
□ Yes有─Please specify請指明：
l. CONTACT PERSON,
IN CASE OF AN
EMERGENCY
緊急事件聯絡人
Name 姓名: Relationship 關係:
Address 地址:
Tel 電話: E-mail 電子郵件:
2. LANGUAGE PROFICIENCY 語言能力
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LANGUAGE
PROFICIENCY
語言能力
COMPREHENSION
聽
READING 讀
WRITING 寫
SPEAKING 說
Excellent
優
Good
良
Fair
可
Excellent
優
Good
良
Fair
可
Excellent
優
Good
良
Fair
可
Excellent
優
Good
良
Fair
可
CHINESE
ENGLISH
Other
(please state)
3. EDUCATIONAL BACKGROUND 教育背景
Level 程度
Name of Institution
校名
Country/City
地點
Period of Enrollment
修業年限
Secondary
Education 中學
Undergraduate Level
Education 大學
Graduate Level
Education 研究所
4. REFERENCES 推薦單位 (人) 資料
Name 姓名
Position 職務
Phone , E-Mail or Mailing Address 電話及郵電地址
5. PREVIOUS EMPLOYMENT
工作經歷
(Use one line for each position)
Position
職務
Company/Organization
機構名稱
Period of Employment
服務期間
Responsibilities
工作說明
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6. PRESENT EMPLOYMENT 現職狀況
a. COMPANY/
ORGANIZATION
機構名稱
b. POSITION
職稱
c. From 起始日期
d. CONTACT
INFORMATION
聯絡資訊
Address 地址：
Tel 電話：
Fax 電傳： E-mail 電子郵件：
e. TYPE OF
ORGANIZATION
機構種類
□ Govt. Ministry/
□ University/
□ Govt./State-owned
Agency 政府部門
Institution 大學校院
Enterprise 公營企業
□ Locally-owned
□ Joint Venture □ Foreign-owned □ NGO
Enterprise 私人企業
合資企業 Enterprise 國際公司 非政府機構
7. LANGUAGE CENTER WHERE YOU PLAN TO ATTEND IN TAIWAN 擬就讀之語文中心 (For information
about university-affiliated language centers in Taiwan, please visit the following website for reference:
https://ws.moe.edu.tw/001/Upload/7/relfile/6645/82621/257ffa50-86a9-484e-9bd7-b993b41126cf.pdf)
University-affiliated language center:
8. BRIEFLY STATE YOUR STUDY PLAN WHILE IN TAIWAN 請簡述在台讀書計畫
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(A4 12point
한장정도 재출필요 한국어 혹은 중국어 작성 가능)
9. DECLARATION:
I declare that:
The information I have given on this application is complete and accurate to the best of my knowledge.
Applicant’s Signature Date
_____ /_____/_____
