Application Form Taiwan

APPLICATION FORM FOR ADMISSION 500,Lioufeng Rd. Wufeng, Taichung, Taiwan 41354, R. O. C. http://www.asia.edu.tw 申請人須詳細逐項填/Please type or print clearly. 姓 名

出生日期

(中文 In Chinese)

Date of Birth

Full Name

(Month/Day/Year)

性 別

(英文 In English) (Middle)

(First)

Gender

(Last)

地 址

電 話

Home Address

Telephone

現在通訊處

手機/Cell Phone

Mailing Address

E –mail

出生地點

國 籍

護照號碼

Place of Birth

Nationality

Passport No.

婚姻狀況

子女人數

配偶姓名

Marital Status

No. of Children

Spouse’s Name

男 Male 女 Female

監護人資料 /Information of Legal Guardian 電 話

(中文 In Chinese)

Telephone

姓 名 Full Name

職 業

(英文 In English) (First)

(Middle)

Occupation

(Last)

地 址

與申請人關係

Home Address

Relationship

教育背景 /Education 學歷 Previous Education

學校名稱 Name of School

學校所在地

學位

畢業日期

主修

副修

City and Country

Degree

Graduation Date

Major

Minor

Granted

中等學校 Secondary School

學院/大學 Undergraduate School

研究所 Graduate School

其他訓練 Other Training

1

擬申請就讀之學院或學程及學位 Intended college/program institute and degree of study at Asia University

學院/學程 College/Program

正式生

學位

Registered Student

Degree

選讀生 Non-degree

學士 Bachelor

碩士 Master

博士 Doctor

學士 Bachelor

碩士 Master

博士 Doctor

中文程度 /Chinese Proficiency 曾學習中文幾年？ How long have you studied Chinese?

在何處受何人指導？ Where and under whose guidance did you study Chinese?

是 Yes

是否參加過中文能力測驗？ Have you taken any Chinese language test?

何種測驗？ What kind of test？

分 數

否 No

Score

自我評估中文程度 How do you evaluate your Chinese proficiency?

聽 Listening

 優 Excellent

 佳 Good

 尚可 Average

 差 Poor

說 Speaking

 優 Excellent

 佳 Good

 尚可 Average

 差 Poor

讀 Reading

 優 Excellent

 佳 Good

 尚可 Average

 差 Poor

寫 Writing

 優 Excellent

 佳 Good

 尚可 Average

 差 Poor

英文程度 /English Proficiency 舊制托福成績 Paper-based TOEFL score

新制托福成績 Computer-based TOEFL score

 財力支援 /Financial Support 在本校求學期間各項費用來源 What will be your major financial resource while studying at Asia University?

 個人儲蓄 Personal Savings

 獎助金 Scholarship

 父母供給 Parental Support

 其他 Others (Specify)

 其他資料 /Complementary Information 健康情形 Health Condition

 佳 Good

 尚可 Average

如有疾病或缺陷請敘明之 If you have a health problem, please specify.

工作經歷 2

 差 Poor

Working Experience

著作 Publications

1.

出版日期

2.

出版日期

Date Date

繳交資料記錄表(申請人務必在打勾欄內打) Please check the items that you have submitted.

勾選

繳交資料項目

Check

Required Documentation

份數 Amount

入學申請表

勾選 Check

Required Documentation

留學計畫書中文或英文

2

Completed application form

繳交資料項目

Study plan in Chinese or English

最高學歷之外國學校畢業證書 影本(另附中文或英文翻譯本)

財力證明書(具備足夠在華就學之財力)

1

Financial statement issued by bank

English or Chinese translation of the

份數 Amount 1 1

diploma

最高學歷之外國學校成績單中 文或英文譯本(外國學校須加蓋 章戳或鋼印) Official

transcript

of

1

護照影本 Passport copy

2

申請費用(US$10 匯票或直接至本校出納組 繳費)

1

其他各系所於招生公告訂定之應繳交文 件

1

academic

records in English

推薦書 Letters of recommendation

醫院出具之健康證明書(包括人 類免疫缺乏病毒有關檢查等)

Application fee (send US$10 check or pay personally at Asia University)

Health certification issued within the

Other supplementary documents

last six months

切

結 書 DEPOSITION

一、本人保證未具僑生身分且不具中華民國國籍。 I, the undersigned applicant, guarantee that I am neither an overseas Chinese status nor an R.O.C. national.

二、本人所提供之最高學歷畢業證書(申請大學部者提出高中畢業證書、申請碩士班者提出大學畢業證書、申 請博士班者提出碩士畢業證書)，在畢業學校所在地國家均為合法有效取得畢業資格，並所持之證件相 當於中華民國國內之各級合法學校授予之相當學位。本人在華未以僑生身分申請其他大學校院。 3

The highest-level diploma which I present (high school diploma for undergraduate applicants, university diploma for master program applicants, MA diploma for doctoral program applicants) is valid and was awarded legally in the country where I graduated. The certificate I have is equivalent to that which is awarded by a lawful academic school in the R.O.C. I have not used overseas Chinese status to apply for any other college or university in the R.O.C.

三、本人未曾於中華民國國內各級學校完成申請就學學程或遭退學。 I have never completed or been expelled from any academic program in the R.O.C.

四、上述所陳之任一事項同意授權 貴校查證，如有不實或不符規定等情事，於入學後經查證屬實者，本人 願意接受 貴校註銷學籍處分，絕無異議。 I agree to authorize Asia University to verify the information provided above. If any thereof is found to be false after admission, I will accept revocation of my status as a Asia University registered student.

申請人簽名 Applicant’s Signature

日期 Date

4

ASIA UNIVERSITY INTERNATIONAL STUDENT SCHOLARSHIP APPLICATION 500, Lioufeng Road, Wufeng, Taichung, Taiwan 41354, R. O. C. http://ciae.asia.edu.tw/

Attached photo must be taken within the last 3 months (Approx. size: 1"×2")

Full name: Mailing address: Email address:

Phone number:

Place of birth: Nationality:

Date of birth: Gender:

Marital status:

No. of Children:

What degree and program are you applying for admission of? Program: Degree: Bachelor  Master  Ph.D. List all educational institutions attended. Begin with the highest education. Name of Institutions/Country

Major

Degree

Other Professional Training:

Date(mm/yyyy)

Date:

Check one of the scholarships you are applying for □ Aceh Scholarship (NT$20,000/month)□ Asia U. Founder’s Scholarship (NT $15,000/ month) □ Full Scholarship (NT $60,000/semester)□ Half Scholarship (NT $30,000/semester) If the scholarship you are applying for is not approved, would you like to be considered for other scholarships? 　　 Yes  No If your application is not approved, state your plans for financing your education in Taiwan.

Attach a statement of about 300 words either in Chinese or in English stating your reasons for applying for this scholarship.

5

Applicant’s signature

6

Date