大仁科技大學華語中心入學申請表

If you want the Chinese Language Center to give you a Chinese name, please copy the following sentence into the answer of "Name in Chinese": 「`由華語中心取名」

國籍

Nationality

須與護照相同 Must be the same as shown in your PASSPORT

生日

Date of Birth

MM / DD / YY

性別

Gender

□男 Male

□女 Female

電話

Phone No:

護照號碼

Passport Number

最高學歷

Highest Level of Education

☐ 高中 Senior High School

☐ 大學 University

☐ 研究所 Post-graduate

護照有效期限

Date of Expiration

MM / DD / YY

電子信箱

E-mail

______________________________________

學生繳費、開課...等重要通知，均以電子郵件寄發，請務必提供有效之電子郵件帳號。Please enter your(applicant's) personal email address to stay in touch and keep up-to-date with all our latest news.

通訊地址 Address

_____________________________________________

入學許可會寄到這個地址，請務必以英文或中文詳細正確填寫。

The admission letter will be mailed to this address. Please print clearly inEnglish or Chinese.

是否需要辦理中文研習簽證?

Do your need to apply Visitor Visa?

☐ 否 No ☐ 是 Yes

(依據中華民國政府之規定，須持有中文研習簽證或居留證之外國學生，每週必須上課 15 小時。 According to Ministry of Education regulations, students applying for the visa of studying Chinese or the ARC, must take 15 hours a week.)

在本校研習之經費來源 Major source of financial support during the studies at our school?

☐ 個人儲蓄 Personal Savings ☐ 家人支援 Family Support

☐ 獎學金 Scholarship (☐台灣獎學金 Taiwan Scholarship ☐ 其他 Others: )

☐ 其他 Others:

進修目的或學習計畫 Statement of purpose / Study Plan?

_______________________________________________________________________

_________________________________________________________________________

中文能力 Chinese Proficiency

你學過中文嗎？ Have you ever learnt Chinese? ☐ 學過 Yes ☐ 沒學過 No (以下免填，Please pass the questios blow.)
你學過哪些教材？ What Chinese study materials have you used? 1. 2. 3. 4.
學習中文多久？ How long have you learnt Chinese?				☐ 0-1 year ☐ 1-2 years ☐ 2-3 years ☐ 3 years~
您是否參加過任何中文能力檢定？☐是Yes，請回答下列問題 ☐否No Have you ever taken a Chinese Proficiency Test? ( If yes, please answer the following questions.)
☐TOCFL(TOP-Huayu)		證書Certificate______________；MM / DD / YY
☐漢語水平考試(HSK)		證書Certificate______________；MM / DD / YY
☐其他Other		證書Certificate______________；MM / DD / YY
你覺得你現在的中文能力怎麼樣？How do you think of your Chinese ability?
聽 Listening	☐精通 Excellent		☐佳 Good		☐尚可 Average	☐差 Poor
說 Speaking	☐精通 Excellent		☐佳 Good		☐尚可 Average	☐差 Poor
讀 Reading	☐精通 Excellent		☐佳 Good		☐尚可 Average	☐差 Poor
寫 Writing	☐精通 Excellent		☐佳 Good		☐尚可 Average	☐差 Poor

緊急聯絡人 Emergency Contact Information

姓名 Name		電話 Phone No.
關係 Relationship		地址 Address

在台緊急聯絡人 Emergency Contact Information in Taiwan

姓名 Name		電話 Phone No.
關係 Relationship		地址 Address

醫療保險調查Survey on Medical Insurance

☐已有居留證並加入全民健康保險I hold an ARC and have joined National Health Insurance.

☐已自行投保海外醫療保險 I have overseas medical insurance.

☐我沒有任何保險。I do not have any insurance.

是否需申請宿舍Do you wish to apply for a dorm：□是Yes □否No

☐我要住宿舍2人房apply for dorm 2-shared room.

☐我要住宿舍3人房apply for dorm 3-shared room.

申請所需表件如下：請務必備齊文件，方受理申請 APPLICATION MATERIALS must include-

☐護照影本Photocopy of the first page of the passport

☐二吋半身正面照片2張2 2-inches Photographs

學費退費規定 Refund related regulations

★若因人數不足未能開班時，已繳學費無息退還；若因無法取得簽證入境者，已繳學費無息退還。

開課前學生若因個人因素無法上課，已繳學費不予退還，亦不可轉讓，但可順延一期上課。

開課後學生若因個人因素無法上課，或中途缺課者，已繳學費不予退還，並不得順延一期上課。
In case of no classes due to insufficient number of students, the tuition fees paid will be refunded.
If you are unable to obtain a visa entry, the tuition fees paid will also be refunded.
If one is unable to attend classes due to personal factors before the start of the course, the tuition fees paid will not be refunded and is not transferable, but one can resume class for a grace period of one semester.
After the start of the course, if one is unable to attend classes due to personal factors, or if one is absent from the class during the course, the tuition fees paid will not be refunded, and the class will not be postponed.

☐勾選確認check to confirm

個人資料保護法聲明 Statement of Personal Information Protection Act

本人同意及授權大仁科技大學華語中心所蒐集之個人資訊僅作為華語中心之課務、活動及相關行政業務之使用，亦了解該中心將依個人資料保護法之相關規定妥善管理，未經本人同意，絕不任意對其他第三者揭露。

I hereby consent and authorize Chinese Language Center (CLC) of Tajen University of Languages to collect the personal information that I provide for the purpose of affairs of course, activities and administrative work in CLC. I also understand that CLC will not disclosed this information to third parties without my agreement.

☐勾選確認check to confirm

我已了解大仁科技大學華語中心之華語正規班相關規定，並同意遵守。

I have completely understood all the information indicated by Tajen University Chinese Language Center, and I agree, I will follow the regulations without transgression.

申請人簽名 Applicant Signature 日期 Date：

請寄至: 90741 屏東縣鹽埔鄉維新路20號大仁科技大學華語中心收或 cmchiou@tajen.edu.tw

Mail to Chinese Language Center, Tajen University

No.20, Weixin Rd., Yanpu Township, Pingtung County 90741, Taiwan, R.O.C. or cmchiou@tajen.edu.tw

大仁科技大學華語中心 90741屏東縣鹽埔鄉維新路20號

Chinese Language Center, Tajen University No.20, Weixin Rd., Yanpu Township, Pingtung County 90741, Taiwan, R.O.C TEL: 886-8-7624002#1853

E-mail: cmchiou@tajen.edu.tw

大仁科大華語入學申請書KSU CLC application中英版 odt.pdf

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友善列印