Application Form For ROC (Taiwan) Ministry of Education Huayu Enrichment Scholarship 2021

(For official use only)
附件一 Application No.
110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 2021
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. Please attach a

photograph that has
Surname（Last name）姓：
been taken within the
Given Name(s) 名： last 3 months.
Chinese Name 中文姓名：最近三個月相片
b. CITY and COUNTRY

OF BIRTH
出生城市及國別
*Note: If you are an overseas Chinese student, or hold a valid R.O.C. passport, you
c. NATIONALITY國籍 are not eligible to apply.
d. CONTACT Permanent Address永久地址：

INFORMATION
Mailing Address (If different from above)郵寄地址：
聯絡地址、電話、
Telephone電話： E-mail電子郵件：
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 (Day日／Month 月／Year 年):

日
h. PAST RESIDENCE in
TAIWAN □Never 否; □Yes, from (dd/mm/yr) to (dd/mm/yr);
曾否居住台灣是，起迄日期;
Reason for residence居住事由：
i. Taiwan Scholarship/
Huayu Enrichment
□None 無; □Yes, from (dd/mm/yr) to (dd/mm/yr);是，起迄日期。
Scholarship Award Type(s) of Scholarship Awarded:

1
History台灣獎學金/華
語文獎學金受獎紀錄
j. HEALTH
CONDITION
□ Excellent □ Good □ Fair
健康狀況
k. ANY CHRONIC
DISEASES □ None無
慢性病
□ Yes有─Please specify請指明：
l. CONTACT PERSON, Name姓名: Relationship 關係:
IN CASE OF AN
EMERGENCY Address地址:
緊急事件聯絡人 Tel電話: E-mail 電子郵件:
M. WHERE DID YOU

GET THE
□Taipei Economic and Cultural Mission in Ankara
INFORMATION
ABOUT HUAYU
ENRICHMENT
□Council of Higher Education(Yüksek öğretim Kurulu, YÖK)
SCHOLARSHIP
□University Announcements
如何得知獎學金資訊
□Others (Please Specify)______________________
2. LANGUAGE PROFICIENCY語言能力
COMPREHENSION READING 讀 WRITING 寫 SPEAKING 說
LANGUAGE
PROFICIENCY 聽
語言能力 Excellent Good Fair Excellent Good Fair Excellent Good Fair Excellent Good Fair
優良可優良可優良可優良可
CHINESE
ENGLISH
Other
(please state)
3. EDUCATIONAL BACKGROUND 教育背景

Level 程度 Name of Institution 校名 Country/City Period of Enrollment 修業年限
地點
Secondary
Education 中學
Undergraduate (University) Level

Education
大學
Graduate (Master/PhD) Level
Education
研究所
2
4. REFERENCES 推薦單位 (人) 資料
Name 姓名 Position職務 Phone, E-Mail or Mailing Address電話及電郵
5. PREVIOUS EMPLOYMENT 工作經歷 (Use one line for each position)

Company/Organization Responsibilities
Position 職務 Period of Employment 服務期間
機構名稱工作說明
6. PRESENT EMPLOYMENT 現職狀況
a. COMPANY/
ORGANIZATION
機構名稱
b. POSITION 職稱
c. From起始日期
Address 地址：
d. CONTACT
INFORMATION 聯絡資訊 Tel 電話： Cell phone:
Fax 電傳： E-mail 電子郵件：
e. TYPE OF ORGANIZATION
□ Govt. Ministry/ □ University/ □ Govt./State-owned Agency政府
機構種類部門 Institution大學校院 Enterprise 公營企業
□ Locally-owned □ Joint Venture □ Foreign-owned

私人企業合資企業國際公司
□ NGO Enterprise 非政府機構

7. LANGUAGE CENTER WHERE YOU PLAN TO ATTEND IN TAIWAN 擬就讀之語文中心
8. BRIEFLY STATE YOUR STUDY PLAN WHILE IN TAIWAN 請簡述在台讀書計畫
3
9. WHAT SCHOLARSHIP PERIOD WOULD YOU LIKE TO CHOOSE?
□2 months(01/07/2021-31/08/2021 only) □3 months □ 6 months □9 months □1 year
From dd/mm/yyyy to dd/mm/yyyy (ex. 01/09/2021-31/08/2022)
10. DECLARATION:
I declare that: The information I have given on this application is complete and accurate to the best of my
knowledge.
Applicant’s Signature Date _____(dd) /____ (mm)/______(yyyy)

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(For official use only)

附件一 Application No.

1. PERSONAL DATA 個人基本資料

a.NAME姓名 Title 稱謂： Mr./Mrs./Ms. Please attach a

Chinese Name 中文姓名： 最近三個月相片

b. CITY and COUNTRY

d. CONTACT Permanent Address永久地址：

g. DATE OF BIRTH 生 (Day日／Month 月／Year 年):

Scholarship Award Type(s) of Scholarship Awarded:

緊急事件聯絡人 Tel電話: E-mail 電子郵件:

M. WHERE DID YOU

3. EDUCATIONAL BACKGROUND 教育背景

Undergraduate (University) Level

Name 姓名 Position職務 Phone, E-Mail or Mailing Address電話及電郵

5. PREVIOUS EMPLOYMENT 工作經歷 (Use one line for each position)

6. PRESENT EMPLOYMENT 現職狀況

Fax 電傳： E-mail 電子郵件：

□ Locally-owned □ Joint Venture □ Foreign-owned

□ NGO Enterprise 非政府機構

8. BRIEFLY STATE YOUR STUDY PLAN WHILE IN TAIWAN 請簡述在台讀書計畫

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Chinese Name 中文姓名：最近三個月相片