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					Annex 1
                     NATIONAL TSING HUA UNIVERSITY, TAIWAN
                                               REPUBLIC OF CHINA

                                                                                            
                                  Internship Program Application Form
Part I. Personal Information

 Applicant’s       English
     Name
                                 (Last name)             (Given Name)
                                   /      /                                                              Attach recent
Date of Birth                                             Passport No.
                              (month/ date /year)
                                                                                                       bust photograph

                                                                                   □Male                     here

 Birth Place                               Nationality                   Gender
                                                                                   □Female

    Mailing                                                              E-mail
    Address                                                              address
 Permanent
  Address                                                                                       (if different from above)
   Home            +(      )                                              Mobile
 Telephone         (Country Code)-(Area code)-(Phone Number)              phone

                      Name                                               Relationship
 Emergency
  contact            E-mail                                               Telephone     (   )

                    Address

Part II. Education, Employment and Personal Skills Information

Higher education (college/university):
Clearly state the title of the degree (s), the exact enrollment starting date and the expected graduation
date. Proof of enrollment in school during the requested internship period may be required at a later stage
of the selection process.


                                             City and                                                      Expected
 Institution        Name of School                          Major        Degree     Starting Date
                                              Country                                                   graduation date
  Current
 Education




    Please type in English.

                                                                 Annex 1-NTHU-Internship Program Application From     -1-
Annex 1
                  NATIONAL TSING HUA UNIVERSITY, TAIWAN
                                        REPUBLIC OF CHINA
 Completed
 Education

 Computer           □Word-processing           □ Internet          □Spreadsheet           □Database
  Skills
                    □Web page design           □Other:
Publications
  (if any)

                                                     Reading                    Writing                 Speaking
             Languages Skills
                                                Good         Poor        Good         Poor          Good            Poor
Mother tongue (please specify)                   □            □           □            □             □               □
English                                          □             □          □               □         □               □
Other(Please specify)                            □             □          □               □         □               □
                                                 □             □          □               □         □               □

Scholarships
  /Awards


Career Plans



Part III. Internship Information

Please indicate the preferred                From Date/month/year                         To Date/month/year
internship period:
(maximum 2 months)                                   /         /                                /          /

Other relevant information                                                                Yes                  No
(a)   Have you ever applied for a public sector internship in other countries
                                                                                          □                    □
      before?
(b)   Have you ever been arrested, indicted, or summoned to court as a
      defendant in a criminal proceeding, or been convicted, fined or
      imprisoned for the violation of any law (excluding minor traffic                    □                    □
      violations)? If yes, please explain and attach release documentation
      from the relevant authorities.




                                                               Annex 1-NTHU-Internship Program Application From         -2-
Annex 1
                  NATIONAL TSING HUA UNIVERSITY, TAIWAN
                                       REPUBLIC OF CHINA
   I hereby certify that all of the above statements, answers and information are complete and correct to the best of
   my knowledge and belief, and can be verified at any time.


   Signature: (please type your name)



   ___________________________________ Date: (dd/mm/yyyy) ___________________


Remarks:
1. Before submitting this application, please check that you have:
 (1). answered all the questions on the application form;
 (2). attached a curriculum vitae (CV) and short essay (150-250 words) describing the reasons for
      seeking an internship with the National Tsing Hua University.
2. Please submit all application to the Office of International Affairs (OIA).




***Official Use ********************************************************************


    Department/ Institute                Approval        Disapproval                Signature       /     /



    College                              Approval        Disapproval                Signature       /     /




                                                             Annex 1-NTHU-Internship Program Application From      -3-

				
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