来台短期研究申请表

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1、阳姓一編號:來臺短期研究申請表—ApplicationFormfortheShortTermResearchAward1•申請者須填寫本樣式之申請表.•Appliesntsmustfilloutthisform,orcreateawordprocesseddocumentofanequivalentformat.2申請者須附履行本計畫相關義務簽名之承諾書。•Asignedcopyofthe"TermsandConditionsoftheAward15mustbeattachedtotheapplication3•申請者須提出本申請書完整資料一式三份（一份原件,二份影本

2、）•Applicantsshouldsubmit3copiesofthecompletedapplication(1originaland2photocopies)4.報名截止日期為當年度6月30日(郵件寄抵日).ThedeadlinetosubmitalldocumentsisJun30fh,(thearrivaldateforreceivingmail)eachyear.1.申請人基本資料Generalinformationa)姓名(Name)b)中文姓名(NameinChinese)c)英文姓名(NameinEnglish)Pleaseattachaphotog

3、raphthathasbeentakenwithinthelast3months・最近三個月相片國籍：(Citizenship)洲別：(Continent)口亞洲Asia口美洲theAmericas口歐洲Europe口非洲Africa口大洋洲Oceania請附護照影本含身分照片頁(Pleaseencloseacopyofthepassportwithphotoidentification)*Note:IfyouareanR.O.C.national,orholdavalidR.O.C.passport,youarenoteligibletoapply.性別(Sex)口

4、男性一Male□女性一Female出生年月日(Birthdayyear/month/day)婚姻狀況(MaritalStatus)□單身・Single□已婚・Married現任機構名稱(PresentPosition)曾否居住臺灣(PastresidenceinTaiwan)口否Never;口是Yes,起迄日期from(yr/mm/dd)to(yr/mm/dd);居住事由:reasonforstayinginTaiwan職稱(Position)通訊聯絡地址(Mailingaddress)電話號碼(Telephonenumber)a.公-office)b.宅-home)

5、c.手機號碼-cellphone)傳真號碼(Faxnumber)電子郵件信箱(E-mailaddress)健康狀況(Healthcondition)□Excellent□Good□Fair慢性病(Anychronicdiseases)口無None口有Yes-Pleasespecify請指明：緊急事件聯絡人(Persontocontactincaseof姓名Name:關係Relationship:emergency)地址Address:電話Tel:電子郵件E-mail:2.申請人背景資料Applicantsbackground❷學歴背景(Academichistory)

6、-最高學歷(HighestDegreeObtained)-攻讀學位領域(Youracademicormajorfieldofstudy)■研究所博士課：就讀學校系所名稱，就讀起迄年份(或預定取得學位年度)：Ph.D:institutionattended,yearofcompletion(oryearexpectingtoobtainthedegree):-博士論文題目(Doctoraldissertation)-研究所碩士課：就讀學校系所名稱，就讀起迄年份：(Graduate:institutionattended,yearofcompletion)■大學部:就讀學

7、校系所名稱,就讀起迄年份(Undergraduate:institutionattended,yearofcompletion)❷個人著作、論文之岀版年代和名稱(Titleandpublishingdateofanypublications,papersorarticles)□工作經歷(Workexperience)英文斓熟程度(ProficiencyinEnglish)GoodFairPoor閱讀(Reading寫作(Writing)會話(Speaking)聽力(Comprehension)中文娴熟程度(ProficiencyinChinese)G