20
2 21臺灣獎學金申請表
APPLICATION FORM FOR THE TAIWAN SCHOLARSHIP
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.
本表請申請人詳實工整填寫，慎勿遺漏，以利配合作業，如有需要，申請人可自行以同款紙張加頁說明。
Please check. 請選以下選項
Which type of scholarship are you applying for?
□ Master Scholarship 碩士獎學金
□ Doctoral Scholarship 博士獎學金
1. PERSONAL DATA 個人基本資料
a.NAME 姓名
※ 請記載韓文及英文姓名
(英文名請與護照相同)
※
국문, 영문 성명 모두
기재 (영문 성명은
반드시
여권 표기와 정확히 일치)
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 recent
photograph 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 was an ROC national at the time of your birth,
you are an ROC national as well and therefore not eligible to apply.
Do you hold the Alien Permanent Resident Certificate of ROC?
□Yes □No
PARENT 1 雙親之一
PARENT 2 雙親之二
- 1 -
編號
甲表（新申請者
用）
Form A
(For new
applicants
only)
d. PARENTS’
INFORMATION
家長資料
Name 姓名：
Nationality 國籍：
Place of Birth 出生地：
Name 姓名：
Nationality 國籍：
Place of Birth 出生地：
e. CONTACT
INFORMATION
聯絡地址、電話、
電子郵件
※住址請填寫韓文及英
文，
務必填寫郵遞區號
※
국문, 영문 주소 모두
기재 (우편번호 기재 필수)
Permanent Address 永久地址(英文地址、韓文地址及郵遞區號)
：
(
국문 주소/우편번호)：
(
영문 주소/zip code)：
Mailing Address (If different from above)郵寄地址
(英文地址、韓文地址及郵遞區號)：
(
국문 주소/우편번호)：
(
영문 주소/zip code)：
Telephone
電話：
電子郵件：
Cell phone
手機：
※ 반드시 연락 가능한 휴대폰 번호 및 이메일 주소 기재
※ 면접 안내는 메일로 개별 통지
f. SEX 性別
□ Male 男 □ Female女
g. MARITAL STATUS
婚姻狀況
□ Single單身 □ Married 已婚
h.
DATE of BIRTH
生日
(Day 日／Month 月／Year 年)：
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i.
PAST RESIDENCE in
T
AIWAN 居住臺灣
□Never 否;
□Yes, from (dd/mm/yr) to (dd/mm/yr) 是，起迄日期
j. Taiwan Scholarship/
Huayu Enrichment
Scholarship Award
History 臺灣獎學金/華
語文獎學金受獎紀錄
□None 無;
□Yes, from (dd/mm/yr) to (dd/mm/yr);是，起迄日期
Type(s) of Scholarship Awarded：
k. HEALTH CONDITION
健康狀況
□ Excellent □ Good □ Fair
l. CHRONIC DISEASES
慢性病
□ None 無;
□ Yes 有─Please specify 請指明：
m. CONTACT PERSON,
IN CASE OF AN
EMERGENCY
緊急事件聯絡人
Name 姓名： Relationship 關係：
Address 地址：
Telephone 電話：
E-mail 電子郵件：
Cell phone 手機：
2. LANGUAGE PROFICIENCY 語言能力
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
- 3 -
Level 程度
Name of Institution
校名
Country &City
地點
Period of Enrollment
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
Telephone , E-Mail or Mailing Address 電話及郵電地址
5. PREVIOUS EMPLOYMENT (Use one line for each position) 工作經歷
※ 직무 경험이 없는 경우‘無’로 기재
Position 職務
Company/Organization
機構名稱
Period of Employment
服務期間
Responsibilities
工作說明
6. PRESENT EMPLOYMENT
現職狀況
※ 재직 중인 직장이 없는 경우‘無’로 기재
a. COMPANY/
ORGANIZATION
機構名稱
- 4 -
b. POSITION
職稱
c. From 起始日期
d. CONTACT
INFORMATION
聯絡資訊
Address 地址：
Telephone 電話：
Cell phone 手機：
Fax 傳真： 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 □ International □ NGO
Enterprise 私人企業
合資企業 Enterprise 國際公司 非政府國際組織
f. PRESENT
DUTIES &
YEARS OF
EMPLOYMENT
現任職務及資歷年限
7. UNIVERSITY/DEPARTMENT, WHICH YOU PLAN TO ATTEND IN TAIWAN 擬就讀之大
學校院系所
(不限幾所,表格可自行增加)
University/college and department：
University/college and department：
8. PLEASE BRIEFLY STATE YOUR STUDY PLAN WHILE IN TAIWAN
請簡述在臺
讀書計畫
A4
※
용지 한 장 분량, 글자크기 12point 로 자기소개, 지원동기, 학업계획서 등 작성
※ 분량이 많을 경우 별지 및 붙임자료 제출 가능
※
중국어과정 신청인은 중문으로,
영어과정 신청인은 영문으로 작성
- 5 -
- 6 -
9.HOW DO YOU KNOW TAIWAN SCHOLARSHIP 您如何得知臺灣獎金消息?
□
Taipei Mission in Korea website. 從教育組或代表處網站消息得知
□
Professor 教授推薦
□
Others________________________________________ 其他
10. DECLARATION: I declare that:
□
I am neither concurrently an ROC national, nor an overseas compatriot of the ROC, nor hold the Alien
Permanent Resident Certificate of 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.
11. CHECK LIST
□
Application Form.
□
A copy of the applicant’s passport or other nationality certificates.
□
A copy of the highest degree and academic transcripts.
□
A copy of a language proficiency certificate:
i. A copy of results or certificate for the
“Test of Chinese as a Foreign Language” (TOCFL) Level 3 or above.
ii. 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.
□
A copy of admission application materials to universities/colleges in Taiwan
□
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.
Applicant’s Signature
Date
- 7 -
_____ /_____/_____
- 8 -
