甲表（新申請者用） Form
A (For new
applicants only)
教育部臺灣獎學金申請表(範本)
APPLICATION FORM FOR THE MOE TAIWAN
SCHOLARSHIP
INSTRUCTIONS:
This application form should be typed in English or Chinese 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. 本表請申請人以英文或中文詳實打字工整填寫，慎勿遺
漏，以利配合作業，如有需要，申請人可自行以同款紙張加頁說明。
Please check. 請選以下選項
Which type of scholarship are you applying for?
□ Undergraduate Scholarship 大學獎學金
□ Master Scholarship 碩士獎學金
□ Doctoral Scholarship 博士獎學金
1. PERSONAL DATA 個人基本資料
a.NAME 姓名 (Please
makesure sameasin Title 稱謂： Mr./Mrs./Ms. Please attach a recent
Surname（Last name）姓：
Passport ) photograph taken within the
last 3 months.
Given Name(s) 名 ： 最近三個月相片
Chinese Name 中文姓名：
b. CITYand COUNTRYOF
BIRTH 出生.城市及國別
c. NATIONALITY 國籍
*Note: If one or both of your parents was an ROC national at the time of your birth,
you are an ROC national as well and therefore not eligible to apply.
Do you hold the Alien Permanent Resident Certificate of ROC?
□Yes □No
PARENT 1 PARENT 2
d. PARENTS’
Name 姓名: Nationality Name 姓名: Nationality
INFORMATION 國 籍 : Place of Birth 出 國 籍 : Place of Birth 出
家長資料 生地: 生地:
e. CONTACT Permanent Address 永久地址：
INFORMATION Mailing Address (If different from above) 郵 寄 地 址 ：
聯絡地址、電話、電子郵件 Telephone 電話： E-mail 電 子 郵 件 ：
Cell phone 手機:
f. SEX 性別 □Male 男 □ Female 女
g. MARITAL STATUS
□Single 單身 □Married 已 婚
婚姻狀況
h. DATE of BIRTH (Day 日/Month 月/Year 年):
生日
i. PAST RESIDENCE in □ Never 否 ; □Yes, from
reason for residence 居住事由:
(dd/mm/yr) to (dd/mm/yr).是，起迄日期
TAIWAN 居住臺灣
j. 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:
History 臺灣獎學金/華
語文獎學金受獎紀錄
k. HEALTH CONDITION
健康狀況
□Excellent □Good □ Fair
l. CONTACT PERSON,
Name 姓名: Relationship 關係:
IN CASE OF AN
Address 地址:
EMERGENCY
緊急事件聯絡人 Telephone 電話: E-mail 電子郵件:
Cell phone 手機:
2. LANGUAGE PROFICIENCY 語言能力
COMPREHENSION READING 讀 WRITING 寫 SPEAKING 說
LANGUAGE
聽
PROFICIENCY
Excellent Good Fair Excellent Good Fair Excellent Good Fair Excellent Good Fair
語言能力 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 Country &City Period of Enrollment
校名 地點 修業年限
Secondary
Education 中 學
Undergraduate Level
Education 大 學
Graduate Level
Education 研究所
4. REFERENCES 推薦單位 (人) 資料
Name 姓名 Position 職務 Telephone , E-Mail or Mailing Address 電話及郵電地址
5. PREVIOUS EMPLOYMENT (Use one line for each position) 工作經歷
Position 職務 Company/Organization Period of Employment Responsibilities
機構名稱 服務期間 工作說明
6. PRESENT EMPLOYMENT 現職狀況
a.
COMPANY/
ORGANIZATION
機構名稱
b. POSITION c. From 起始日期
職稱
d. CONTACT Address 地址：
INFORMATION
Telephone 電話： Cell phone 手機:
聯絡資訊
Fax 電傳： E-mail 電子郵件：
e. TYPE OF □ Govt. Ministry/ □University/ □Govt./State-owned
ORGANIZATION Agency 政府部門 Institution 大學校院 Enterprise 公營企業
機構種類 □ Locally-owned □ Joint Venture □ International □ NGO
Enterprise 私人企業 合資企業 Enterprise 國際公司 非政府國際組織
f. PRESENT
DUTIES &
YEARS OF
EMPLOYMENT
現任職務及資歷年限
7. UNIVERSITY/DEPARTMENT, WHICH YOU PLAN TO ATTEND IN TAIWAN
擬就讀之大學校院/系所
University/college and department:
8. PLEASE BRIEFLY STATE YOUR STUDY PLAN WHILE IN TAIWAN 請簡述在臺讀書計
畫
9. DECLARATION: I declare that:
□ I am neither concurrently an ROC national, nor an overseas compatriot of the ROC, nor hold the
Alien Permanent Resident Certificate of ROC;
□ I am not currently undertaking studies in Taiwan for the same educational level as the scholarship type for
which I am applying;
□ I am not applying for this scholarship as an exchange student resulting from an agreement signed between
my home institution and any Taiwan university/college;
□ The information I have given on this application is complete and accurate to the best of my knowledge.
10. CHECK LIST
□ Application Form.
□ A copy of the applicant’s passport or other nationality certificates.
□ A copy of the highest degree and academic transcripts.
□ A copy of admission application materials to universities/colleges in Taiwan
□ A copy of a language proficiency certificate:
1. A copy of results or certificate for the “Test of Chinese as a Foreign Language” (TOCFL) Level3 or above.
2. For applications to all-English programs, a copy of TOEFL test scores or other recognized English
language proficiency exams or degrees awarded in English must be submitted. English-speaking nationals
are exempt from this rule.
□ Two letters of reference signed and sealed in envelopes (i.e. from the principals, professors,
or supervisors). Photo copies and email submissions of letters of recommendation will not
be considered.
□ Additional documents as specified by the individual representative offices.
Applicant’s Signature
Date
/ /
