CANDIDATE�S BIO-DATA FORM - DOC - DOC

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					             Application Form for ROC (Taiwan)                                                                         Please attach a
                                                                                                                       photograph that
                     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.)
□ No.

1. PERSONAL DATA

NAME
                                (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
                                                                       □Married
AGE                                                                   PAST RESIDENCE IN TAIWAN
PLACE OF BIRTH                                                        □Never □Yes, from (dd/mm/yy) to (dd/mm/yy)
                                                                      Reason for residence:
CONTACT                Tel.:                                          Address:
INFORMATION            Mobile:
                       Fax:
                       Email:
HEALTH CONDITION       □ Excellent □ Good □ Fair
ANY CHRONIC
DISEASES               □None □ Yes. If yes, Please specify.
CONTACT PERSON,        Name:                                          Email:
IN CASE OF             Relationship:                                  Address:
EMERGENCY
                       Tel.:
                       Mobile:

2. LANGUAGE PROFICIENCY
  LANGUAGE          COMPREHENSION                     READING                             WRITING                      SPEAKING
 PROFICIENCY
                   Excellent   Good   Fair    Excellent   Good      Fair      Excellent     Good      Fair     Excellent   Good        Fair

                                                             -1-
    CHINESE
    ENGLISH


3. EDUCATIONAL BACKGROUND
                                                                   Degree                           Period of
         Level                    Name of Institution                            Country/City
                                                                   Major                           Enrollment
Secondary Education
Undergraduate Level
Education
Graduate Level Education


4. EMPLOYMENT RECORD
 Experience                Position                     Company/Organization                Employment Period
  Previous
  Previous
  Present


5. REFERENCES

          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
                                                                            _____ /_____/_____




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posted:7/27/2012
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