（类别一）国立中央大学物理学系上诠光-补助学生出国交流.docVIP

(類別一)國立中央大學物理學系上詮光纖獎學金申請表-補助學生出國交流 (Category 1) National Central University Department of Physics: FOCI scholarship application form for financial assistance for students studying abroad 申請人姓名Applicants Name 中文 Chinese Name 系所及年級Department and Year of Study 英文English Name 身份證字號(居留證號)ID No(ARC No) 學號School Number 聯絡電話Telephone 分機 手機 Extension Cell 電子郵件信箱 Email 出國時間 Duration of stay overseas 自 年 月 日至 年 月 日From ____Year ___ Month ___ Day Until ____Year ___ Month ___ Day 地點(國、州、城市)Destination (Country, State/Province/ City) 研修或實驗計畫Study or experiment plans 邀請單位是否已補助費用Has the inviting department already provided financial aid? □否No □是 □機票費__________元□生活費__________元□其他__________元Yes Air fare_______NTD Living Expenses _______NTD Other _______NTD 有無向其他機構申請補助Has the applicant applied for financial assistance from other departments? □無 No □有 機構名稱______________________ 金額_____________元 Yes Institute name: ________________ Amount: _______NTD 欲申請補助項目及金額Desired category of assistance and amount 機票費 ___________元Air fare _________NTD 生活費 ___________元 (說明：US$______/天 * ____天 * 滙率______)Living Expenses ______NTD (Explanation: US$ required per day times number of days spent abroad times current exchange rate) 其他 ___________元Other ________NTD 合計： ___________元Total: _________NTD 補助項目及金額 (由審查委員會填寫) Approved financial aid(for reviewer’s use only) 機票費 ___________元Air fare _________NTD 生活費 ___________元Living Expenses _________NTD 其他 ___________元Other _______NTD 合計： ___________元Total: _____________NTD 檢附文件 Required documents 邀請單位邀請函或證明文件Invitation from the inviting group or other documents providing proof of invitation. 指導教授推薦函Advisor recommendation letter 歷年成績單Student’s grade transcripts 其他有助審查之資料Any other documents that can assist in the review process. 獲同意補助者，於返國後須檢附相關核銷文件與出國報告書申請補助。Those approved for financial aid must provide a report and documents verifying their trip in order to recei