2024 Fall Semester 【 IAC Program】Admission Application Form for New Southboud Students

以下是你輸入的報名資料,確認請點擊確認資料

*申請就讀學期Apply for::

*申請人姓名 / Applicant's Name 【in Chinese】:

*First name / Given name:

*(Last name/ Surname):

*性別:

*國籍Nationality:

護照號碼Passport No.:

身分證號碼Personal ID No.:

*出生地點Place of birth:

*出生日期Date of birth:

*擬申請就讀產學專班之系(所)The Department / Graduate Institute & Degree you apply for:

*第一志願系所1st Choice:

*第二志願系所2nd Choice:

*第三志願系所3rd Choice:

*現在住址Current address:

*Zip code (Current address):

*※現在住址為本校郵寄錄取通知用地址，請詳細填寫，若地址不全或無人接收致使資料無法寄達，由申請者自行負責。:

居留證號(ARC):

*連絡電話Telephone:

*電子信箱E-mail；；CTU-OIA will contact you by email after receive your online application form:

婚姻狀況Marital status:

子女數No. of children:

社群軟體帳號social media - Line:

社群軟體帳號social media - WeChat:

社群軟體帳號social media - WhatsAPP:

社群軟體帳號social media - 其他:

*3. 父母及聯絡人資料Guardian Information:

*監護人Guardian Name:

*連絡電話Parents'Telephone:

*監護人電子郵箱e-mail of guardian:

*監護人國籍Guardian Nationality:

如監護人任一方具中華民國國籍，需填寫下列資訊The following information is required for the guardian with ROC citizenship.；中文姓名 & ROC ID Number:

*緊急聯絡人Emergency Contact Person；NAME & Phone Number:

*4. 高中以上教育背景Applicant’s Education Background:

*學校名稱Name of school:

*學校所在地City and country of your school:

*畢業日期Graduate year:

主修Major /大專以上才需填寫Fill in if you haveCollege Background:

Tell us for more detail about your education background:

母語Native language:

*5. 中、英文語文能力 Chinese and English Proficiency:

曾修讀中文幾年How many years have you formally studied Chinese?:

學習中文環境為何？(高中、大學、語文機構)Where did you study Chinese? (High School, College or language institute?):

*是否參加過中文語文測驗？Have you taken any Chinese proficiency test?:

*中文測驗名稱What is the name of the test?:

*中文測驗日期Date of Test:

*中文能力等級Level / Score:

中文能力自我評估 Please evaluate your Chinese language skills.:

*中文-聽Listening:

*中文-說Speaking:

*中文-讀Reading:

*中文-寫Writing:

*英文程度 Level of English proficiency:

*英文-聽Listening:

*英文-說Speaking:

*英文-讀Reading:

*英文-寫Writing:

*是否參加過英文語文測驗？Have you taken any English proficiency test?:

*何種測驗？What is the name of the test?:

*英文測驗日期Date of Test:

成績等級Score / Level:

*6. 健康情形Health Condition:

特康殊健需求Additional Needs；:

*7. 在建國科大研習期間各項費用來源？Financial support while studying at CTU？:

非本人之財力需繳付關係證明及財力保證書:

上傳最近二吋相片 up-load a recent photograph here （about 1”x2”）:

上傳護照up-load your passport or personal identification card:

*我知道我還需要email其他申請入學之必要文件 I understand I have to send those required documents by email:

*【附表Attachment 1】入學申請資料檢核表List of Submitted Documents:

*【Check the items that you have to send by Email】新南向產學專班入學申請資料檢核表 List of Submitted Documents:

畢業證書Diploma:

歷年成績單 Transcripts of academic records:

建國科技大學 - 國際合作及交流處 Office of International Affairs

新南向國際學生產學合作專班(Industry-Academia Collaboration Programs)