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2017
APPLICATION FORM FOR A TAIWAN SCHOLARSHIP
INSTRUCTIONS:
This application form should be typed 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.
Please check.
1. PERSONAL DATA
Chinese Name
Cell phone :
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TETO in Indonesia
l. HEALTH CONDITION
Excellent Good Fair
m. CHRONIC DISEASES
None
Yes Please specify
Telephone : E-mail :
Cell phone :
2. LANGUAGE PROFICIENCY
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TETO in Indonesia
COMPREHENSION
LANGUAGE READING WRITING SPEAKING
PROFICIENCY
Excellent Good Fair Excellent Good Fair Excellent Good Fair Excellent Good Fair
CHINESE
ENGLISH
3. EDUCATIONAL BACKGROUND
Name of Institution Country &City Period of Enrollment
Level
Secondary
Education
Undergraduate Level
Education
Graduate Level
Education
4. REFERENCES ()
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TETO in Indonesia
6. PRESENT EMPLOYMENT
a. COMPANY/
ORGANIZATION
b. POSITION
c. From
Address
d. CONTACT
INFORMATION Telephone Handphone :
Fax E-mail
Enterprise Enterprise
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TETO in Indonesia
f. PRESENT
DUTIES &
YEARS OF
EMPLOYMENT
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TETO in Indonesia
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 with Photo
A copy of Indonesia Passport
A copy of Kartu Keluarga
A copy of the highest degree and academic transcripts
A copy of admission application materials to Taiwan Scholarship Cooperative Universities
A copy of a language proficiency certificate
Two letters of reference signed and sealed en envelopes. Photo copies and email
submissions of letters of recommendation will not be considered.
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TETO in Indonesia
Applicants Signature
Date
_____ /_____/_____
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