CANDIDATE�S BIO-DATA FORM - DOC 6

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					                        台灣研究訪問學者計畫申請表
                        APPLICATION FORM
         2011 FACULTY RESEARCH GRANT FOR TAIWAN STUDIES

1. PERSONAL DATA 個人基本資料
  a.NAME 姓名             Mr./Mrs./Ms.
                                                                                    Please attach a photograph

                                       Surname(Last name)姓                          that has been taken within
                                                                                    the last 3 months after
                           Given Name 名(First Name)           Middle Name           having signed the reverse
                                                                                    side.
  b. HOME ADDRESS
                        Address:
  聯絡地址、電話、電郵                                                                                最近三個月相片
                        Telephone:

                        E-mail:
  c.. BIRTH PLACE 出生地


  d. NATIONALITY 國籍
                        P.S.: Holders of ROC passports are not eligible to apply.


  e. SEX 性別:              □ Male 男           □ Female 女


 f. MARITAL STATUS 婚姻     □Single 單身         □ Married 已婚



  g.DATE OFBIRTH 生日       (Day 日/Month 月/Year 年):

  h. CONTACT PERSON, IN Name 姓名:                                Relationship 關係:
    CASE OF
    EMERGENCY           Address 地址:
   緊急事件聯絡人
                        Tel 電話:                                E-mail 電郵:



2. EDUCATIONAL BACKGROUND 教育背景

       Level                  Name of Institution                 Location          Period of Schooling
       程度                           校名                              地點                   修業年限
Undergraduate
Level Education 大學




                                               -1-
 Graduate     Level
 Education 研究所



3. PREVIOUS EMPLOYMENT (Use one line for each position) 以往工作經歷

                      COMPANY/ORGANIZATION            PERIOD OF          DUTIES
  POSITION 職務
                            機構名稱                  EMPLOYMENT 服務期間        工作說明




4. PRESENT EMPLOYMENT 現職狀況

  a. COMPANY/
       ORGANIZATION
       機構名稱


  b. POSITION 職稱                                        Since 起始日期


  c.
       ADDRESS 地址
                        Tel 電話:
                        Fax 電傳:                         E-mail 電子郵件:



5. RESEARCH CONTENT 研究內容

  RESEARCH TOPIC

  研究主題

  COUNTERPART IN TAIWAN

  在台研究機構

  SCHEDULE TO VISIT TAIWAN          From: Day 日     /Month 月   /Year 年

  預定訪台日期                            To:   Day 日    /Month 月    /Year 年

  CONTACT INFORMATION IN

  TAIWAN 在台聯絡通訊



                                             -2-
6. DECLARATION
   I declare that the information I have given in this application is complete and accurate to the best of my knowledge.

  Applicant’s Signature                                         Date

                                                                   _____ /_____/_____




                                                       -3-
                                         Research Proposal
 Research field:

 Research topic or title:

 Names of journals in which the final manuscript may be accepted for publication:


 Conferences and seminars where the results of your research may be presented:




a) Summary of research proposal:




b) Please provide a concise research proposal which will include the following: :




                                                   -4-

				
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