Annex 1

NATIONAL TSING HUA UNIVERSITY, TAIWAN

REPUBLIC OF CHINA


Internship Program Application Form
Part I. Personal Information

Applicant’s English
Name
(Last name) (Given Name) Attach recent
/ / bust photograph
Date of Birth Passport No.
(month/ date /year)
here
□Male
Birth Place Nationality Gender
□Female
Mailing E-mail
Address address
Permanent
Address (if different from above)
Home +( ) Mobile
Telephone (Country Code)-(Area code)-(Phone Number) phone

Name Relationship
Emergency
contact E-mail Telephone ( )

Address

Part II. Education, Employment and Personal Skills Information

Higher education (college/university):

Clearly state the title of the degree (s), the exact enrollment starting date and the expected graduation
date. Proof of enrollment in school during the requested internship period may be required at a later stage
of the selection process.

City and Expected

Institution Name of School Major Degree Starting Date
Country graduation date
Current
Education
Completed
Education


Please type in English.

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Annex 1
NATIONAL TSING HUA UNIVERSITY, TAIWAN
REPUBLIC OF CHINA

Computer □Word-processing □ Internet □Spreadsheet □Database

Skills
□Web page design □Other：
Publications
(if any)

Reading Writing Speaking

Languages Skills
Good Poor Good Poor Good Poor
Mother tongue (please specify) □ □ □ □ □ □
English □ □ □ □ □ □
Other(Please specify) □ □ □ □ □ □
□ □ □ □ □ □

Scholarships
/Awards

Career Plans

Part III. Internship Information

Please indicate the preferred From Date/month/year To Date/month/year

internship period：
(maximum 2 months) / / / /

Other relevant information Yes No

(a) Have you ever applied for a public sector internship in other countries
□ □
before?
(b) Have you ever been arrested, indicted, or summoned to court as a
defendant in a criminal proceeding, or been convicted, fined or
imprisoned for the violation of any law (excluding minor traffic □ □
violations)? If yes, please explain and attach release documentation
from the relevant authorities.
I hereby certify that all of the above statements, answers and information are complete and correct to the best of
my knowledge and belief, and can be verified at any time.

Signature: (please type your name)

___________________________________ Date: (dd/mm/yyyy) ___________________

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Annex 1
NATIONAL TSING HUA UNIVERSITY, TAIWAN
REPUBLIC OF CHINA
Remarks:
1. Before submitting this application, please check that you have:
(1). answered all the questions on the application form;
(2). attached a curriculum vitae (CV) and short essay (150-250 words) describing the reasons for
seeking an internship with the National Tsing Hua University.
2. Please submit all application to the Office of International Affairs (OIA).

***Official Use ********************************************************************

Department/ Institute  Approval  Disapproval Signature / /

College  Approval  Disapproval Signature / /

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