教育部華語文獎學金申請表-taiwan.docVIP

PAGE  PAGE 4 附件一 105學年度教育部華語文獎學金申請表 Application Form for ROC (Taiwan) Ministry of Education Huayu Enrichment Scholarship 2016 INSTRUCTIONS: This application form should be typed and completed by the applicant. Each question must be answered clearly and completely. Detailed answers are required in order to make the most appropriate arrangements. If necessary, additional pages of the same size may be attached. 申請人請詳實工整填寫，慎勿遺漏，以利配合作業，如有需要，可自行以同款紙張加頁說明。 1. PERSONAL DATA 個人基本資料 a.NAME姓名 Title 稱謂： Mr./Mrs./Ms. Surname（Last name）姓： Given Name(s) 名： Chinese Name 中文姓名： Please attach a photograph that has been taken within the last 3 months. 最近三個月相片 b. CITY and COUNTRY OF BIRTH 出生城市及國別  c. NATIONALITY國籍 *Note: If you are an overseas Chinese student, or hold a valid R.O.C. passport, you are not eligible to apply. d. CONTACT INFORMATION 聯絡地址、電話、 電子郵件 Permanent Address永久地址： Mailing Address (If different from above)郵寄地址： Telephone電話： E-mail電子郵件： Cell phone: e. SEX性別 □ Male 男 □ Female女 f. MARITAL STATUS 婚姻狀況  □ Single單身 □ Married 已婚 g. DATE OF BIRTH 生日  (Day日／Month 月／Year 年): h. PAST RESIDENCE in TAIWAN 曾否居住台灣 □Never 否; □Yes, from (dd/mm/yr) to (dd/mm/yr);是，起迄日期; reason for staying in Taiwan居住事由: i. Taiwan Scholarship/ Huayu Enrichment Scholarship Award History台灣獎學金/華語文獎學金受獎紀錄 □None 無; □Yes, from (dd/mm/yr) to (dd/mm/yr);是，起迄日期。 Type(s) of Scholarship Awarded: j. HEALTH CONDITION 健康狀況 □ Excellent □ Good □ Fair k. ANY CHRONIC DISEASES 慢性病 □ None無 □ Yes有─Please specify請指明： l. CONTACT PERSON, IN CASE OF AN EMERGENCY 緊急事件聯絡人 Name姓名: Relationship 關係: Address地址: Tel電話: E-mail 電子郵件: M. where did you get the information about Huayu Enrichment Scholarship 如何得知獎學金資訊□Taipei Economic and Cultural Mission in Ankara □Council of Higher Education(Yü