Application Form for ROC (Taiwan) Please attach a
Taiwan Scholarship has been taken
within the last 3
This application form should be TYPED and completed by the applicant. months.
If necessary, additional pages of the same size may be attached .
Which type of scholarship would you like to apply for?
□ Master Scholarship □ Doctoral Scholarship
University/Department plan to attend: _________________________________________
Do you need to attend a Chinese Language Enrichment Program (The LEP must be
undertaken during the first year)?
□ Yes, University affiliated language center plan to attend: ____________________________
(Please apply for admissions to a degree program for the 2011 academic year.)
1. PERSONAL DATA
(Last name) (Given Name) (Chinese Name, if applicable)
FATHER’S NAME (Last name) (Given Name) (Chinese Name, if applicable)
MOTHER’S NAME (Last name) (Given Name) (Chinese Name, if applicable)
Note: If one or both of your parents were an ROC national at the time of your
NATIONALITY birth, you are an ROC national as well and therefore not eligible to apply.
DATE OF BIRTH (dd/mm/yy) □Single □Female □Male
AGE PAST RESIDENCE IN TAIWAN
PLACE OF BIRTH □Never □Yes, from (dd/mm/yy) to (dd/mm/yy)
Reason for residence:
CONTACT Tel.: Address:
HEALTH CONDITION □ Excellent □ Good □ Fair
DISEASES □None □ Yes. If yes, Please specify.
CONTACT PERSON, Name: Email:
IN CASE OF Relationship: Address:
2. LANGUAGE PROFICIENCY
LANGUAGE COMPREHENSION READING WRITING SPEAKING
Excellent Good Fair Excellent Good Fair Excellent Good Fair Excellent Good Fair
3. EDUCATIONAL BACKGROUND
Degree Period of
Level Name of Institution Country/City
Graduate Level Education
4. EMPLOYMENT RECORD
Experience Position Company/Organization Employment Period
Name Position Company Phone, Mobil, Email, Address
6. PLEASE BRIEFLY STATE YOUR STUDY PLAN WHILE IN TAIWAN
7. DECLARATION: I declare that:
□ I am neither concurrently an ROC national, nor an overseas compatriot of the 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.
Applicant’s Signature Date