APPLICATION FORM FOR ADMISSION

500,Lioufeng Rd.
Wufeng, Taichung, Taiwan 41354, R. O. C.
http://www.asia.edu.tw
申請人須詳細逐項填/Please type or print clearly.

(中文 In Chinese) 出生日期

姓 名 Date of Birth
Full Name (Month/Day/Year)

(英文 In English) 性 別 男 Male

(First) (Middle) (Last) Gender 女 Female

地 址 電 話
Home Address Telephone

現在通訊處 手機/Cell Phone

Mailing Address E –mail

出生地點 國 籍 護照號碼
Place of Birth Nationality Passport No.
婚姻狀況 子女人數 配偶姓名
Marital Status No. of Children Spouse’s Name

監護人資料/Information of Legal Guardian

(中文 In Chinese) 電 話
姓 名 Telephone
Full Name
(英文 In English) 職 業

(First) (Middle) (Last) Occupation

地 址 與申請人關係
Home Address Relationship

教育背景/Education

學歷 學校名稱 學校所在地 學位 畢業日期 主修 副修

Previous Education Name of School City and Country Degree Graduation Date Major Minor
Granted
中等學校
Secondary School

1
 學院/大學
Undergraduate
School
研究所
Graduate School
其他訓練
Other Training

擬申請就讀之學院或學程及學位
Intended college/program institute and degree of study at Asia University

學院/學程
College/Program

正式生 學士 Bachelor 碩士 Master 博士 Doctor

學位
Registered Student
Degree
選讀生 學士 Bachelor 碩士 Master 博士 Doctor
Non-degree

中文程度/Chinese Proficiency

曾學習中文幾年？
How long have you studied Chinese?
在何處受何人指導？
Where and under whose guidance did you study Chinese?
何種測驗？
是否參加過中文能力測驗？
是 Yes
What kind of test？
Have you taken any Chinese language test?
分 數
否 No
Score
自我評估中文程度
How do you evaluate your Chinese proficiency?

聽 Listening  優 Excellent  佳 Good  尚可 Average  差 Poor

說 Speaking  優 Excellent  佳 Good  尚可 Average  差 Poor

讀 Reading  優 Excellent  佳 Good  尚可 Average  差 Poor

寫 Writing  優 Excellent  佳 Good  尚可 Average  差 Poor

英文程度/English Proficiency
舊制托福成績 新制托福成績
Paper-based TOEFL score Computer-based TOEFL score

2
 財力支援/Financial Support
在本校求學期間各項費用來源
What will be your major financial resource while studying at Asia University?

 個人儲蓄 Personal Savings  獎助金 Scholarship

 父母供給 Parental Support  其他 Others (Specify)

其他資料/Complementary Information
健康情形  佳 Good  尚可 Average  差 Poor
Health Condition
如有疾病或缺陷請敘明之
If you have a health problem, please specify.
工作經歷
Working Experience

1. 出版日期
著作
Date
Publications
2. 出版日期
Date

繳交資料記錄表(申請人務必在打勾欄內打)
Please check the items that you have submitted.

勾選 繳交資料項目 份數 勾選 繳交資料項目 份數
Check Required Documentation Amount Check Required Documentation Amount

入學申請表 留學計畫書中文或英文
2 1
Completed application form Study plan in Chinese or English
最高學歷之外國學校畢業證書
影本(另附中文或英文翻譯本) 財力證明書(具備足夠在華就學之財力)
English or Chinese translation of the 1 Financial statement issued by bank
1
diploma
最高學歷之外國學校成績單中
文或英文譯本(外國學校須加蓋
護照影本
章戳或鋼印)
1 Passport copy 1
Official transcript of academic
records in English
申請費用(US$10 匯票或直接至本校出納組
推薦書
2 繳費)
Letters of recommendation
Application fee (send US$10
check or pay personally at Asia
3
勾選 繳交資料項目 份數 勾選 繳交資料項目 份數
Check Required Documentation Amount Check Required Documentation Amount
University)

醫院出具之健康證明書(包括人
其他各系所於招生公告訂定之應繳交文
類免疫缺乏病毒有關檢查等)
1 件
Health certification issued within the
Other supplementary documents
last six months

切 結 書 DEPOSITION

一、本人保證未具僑生身分且不具中華民國國籍。

I, the undersigned applicant, guarantee that I am neither an overseas Chinese status nor an R.O.C. national.

二、本人所提供之最高學歷畢業證書(申請大學部者提出高中畢業證書、申請碩士班者提出大學畢業證書、申
請博士班者提出碩士畢業證書)，在畢業學校所在地國家均為合法有效取得畢業資格，並所持之證件相
當於中華民國國內之各級合法學校授予之相當學位。本人在華未以僑生身分申請其他大學校院。

The highest-level diploma which I present (high school diploma for undergraduate applicants, university diploma for
master program applicants, MA diploma for doctoral program applicants) is valid and was awarded legally in the country
where I graduated. The certificate I have is equivalent to that which is awarded by a lawful academic school in the R.O.C.
I have not used overseas Chinese status to apply for any other college or university in the R.O.C.

三、本人未曾於中華民國國內各級學校完成申請就學學程或遭退學。

I have never completed or been expelled from any academic program in the R.O.C.

四、上述所陳之任一事項同意授權 貴校查證，如有不實或不符規定等情事，於入學後經查證屬實者，本人
願意接受 貴校註銷學籍處分，絕無異議。

I agree to authorize Asia University to verify the information provided above. If any thereof is found to be false after
admission, I will accept revocation of my status as a Asia University registered student.

申請人簽名 日期
Applicant’s Signature Date

4
 Attached photo
ASIA UNIVERSITY must be taken
within the last 3
INTERNATIONAL STUDENT months
(Approx. size:
SCHOLARSHIP APPLICATION 1"×2")
500, Lioufeng Road, Wufeng,
Taichung, Taiwan 41354, R. O. C.
http://ciae.asia.edu.tw/

Full name:

Mailing address:

Email address: Phone number:

Place of birth: Date of birth:

Nationality: Gender: Marital status: No. of Children:

What degree and program are you applying for admission of?
Program:

Degree: Bachelor  Master  Ph.D.

List all educational institutions attended. Begin with the highest education.
Name of Institutions/Country Major Degree Date(mm/yyyy)

Other Professional Training: Date:

Check one of the scholarships you are applying for

□ Aceh Scholarship (NT$20,000/month)□ Asia U. Founder’s Scholarship (NT $15,000/ month)
□ Full Scholarship (NT $60,000/semester)□ Half Scholarship (NT $30,000/semester)
If the scholarship you are applying for is not approved, would you like to be considered for other
scholarships? 　　 Yes  No
If your application is not approved, state your plans for financing your education in Taiwan.

Attach a statement of about 300 words either in Chinese or in English stating your reasons for
applying for this scholarship.

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Applicant’s signature Date