大仁科技大学外国籍学生奖助学金申请表.doc

大仁科技大學外國籍學生獎助學金申請表 Tajen University Foreign Student Scholarship Application Form Please complete in English except where asked to use Chinese. 1. Name姓名 : (in English):Name姓名: (in Chinese):Title抬頭:2. Sex姓別: 3. Marital Status婚姻狀況: 4. Nationality國籍:5. Date of Birth生日:6. Contact address聯絡住址: (in Chinese) 7. Contact address聯絡住址: (in English) Tel (H): . (O): Fax / Email: .8. Education Background (Please enclose certified Chinese or English translations of your transcripts.) 教育背景(請附上中文或英文之在學成績單)Institution 學校From (d/m/y)To (d/m/y)Major主修Qualification Obtained學歷9. Employment Background 就業背景 Please provide details of past and current work experienceEmployerFrom (d/m/y)To (d/m/y)Position & Nature of Duties10. Additional Information 其他個人資訊(Please provide information about the reasons for choosing your area of study or research, any relevant work experience; and your intended future career.)11. Chinese Language Proficiency中文程度Please provide evidence of your Chinese Language ability.To what extent do you use Chinese in your work or in your studies?12. Universities Applied其他已申請之學校（請列出您已申請之學校及系所）(Please give details, in order of preference, of the universities and courses for which you have applied)Institution Name學校名稱Course Name 系所名稱Type of Qualification(e.g. BS,MA, MSc,) 學位Current status of application *申請狀況1.2.3.4.5.* If you have not received an offer yet, please write NO* If you have been awarded an unconditional offer, please write UCO* If you have been awarded a conditional offer, please write CO (Please enclose a copy of your letter of offer)13. Date Available for Study in Taiwan, ROC? .day.month.year何時可在臺灣就讀? 14. Referees推薦人(Please ask two people to provide written references on your behalf, using the standard form. Please copy the standard form if you need more copies.)Referee 1 Referee 2Name Name OccupationOccupationAddressAddressTelephoneTelephone15. Declaration 聲明I certify that I am normally resident in and that, to the best of my belief, the statements made in this application are true. I have read and understood the Scholarship Regulations. Signature:Date:請填妥申請書連同其他文件，於6月30日前郵寄至以下地址：Please send your completed application form, together with all dossiers, to the Office of Academic Affairs at the address below to arrive no later than June 30, 2006:Ce