Attachment 1: Application Form for International Students Admissions

China Medical University

(PERSONAL INFORMATION)
___________________

Application Number
For Official Use Only

()

()

(Last Name)

(First Name)

Name in English

Mailing Address

Telephone

Gender

Mobile Phone

Email

Marital Status

Nationality

(Married)
(Single)

Attach recent
photograph here
(about 1x 2)

(Male)
(Female)

Date of
Birth

(Month)

(Day)

(Year)

Place of
Birth

? Have you ever held an R.O.C. nationality?

(Holding an R.O.C. nationality now)
(Have given up R.O.C. nationality officially)
(Date of Issue)_________________________( month/ day / year)
(Never)
?Have you ever had a household registered in Taiwan? (Yes) (No)

Health Condition

Fathers Name

Fathers Nationality

(Specify your health problems, if any)

Fathers Birth Place

?
Has your father ever held an R.O.C. nationality and
had a household registered in Taiwan?
(Yes) ID No. _________________________
(No)

Mothers Birth Place

?
Has your mother ever held an R.O.C. nationality and
had a household registered in Taiwan?
(Yes) ID No.

__________________________
Mothers Nationality
(No)

1
( 69 2 9 ())
2

ROC nationality mentioned above is defined in accordance with Article 2 ofNationality Act:
A person shall have the nationality of the ROC under any of the conditions provided by the following
Subparagraphs:
1 His/her father or mother was a national of the ROC when he/she was born.
2 He/she was born after the death of his/her father or mother, and his/her father or mother was a national of
the ROC at the time of death.
3 He/she was born in the territory of the ROC, and his/her parents cant be ascertained or both were stateless
persons.
4 He/she has undergone the naturalization process.

Mothers Name

(Continued on next page )

CONTACT PERSON IN TAIWAN

Name

Relationship

Telephone

Email

Address in Taiwan
(EDUCATIONAL BACKGROUND)

City and
Country

School Name

High School

Degree
Conferred

Period

Major
(mm)/(yyyy)

(mm)/(yyyy)

College or
University

Degree
Conferred

Period

Major

(mm)/(yyyy)

(mm)/(yyyy)

City and
Country

Name of School

Master Program

Degree
Conferred

Period

Major
(mm)/(yyyy)

(mm)/(yyyy)

City and
Country

Name of School
Ph. D. Program

City and
Country

Name of School

Degree
Conferred

Period

Major

(mm)/(yyyy)

(mm)/(yyyy)

() DEPARTMENT/GRADUATE INSTITUTE AND DEGREE SOUGHT

Priority

Department/Institute you wish to apply

()
What are your major financial resources
during your studies at CMU?
(you can choose more than one)

Degree Program

Bachelor / M.D /D.D.S

Master
Ph. D.
Bachelor / M.D /D.D.S
Master
Ph. D.
Bachelor / M.D /D.D.S
Master
Ph. D.

Taiwan Scholarship
Personal Savings
Parental Support
Other scholarships or funds

(Please
specify)____________________________________
(Continued on next page )

(CHINESE PROFICIENCY LEVEL)

Listening

Excellent Good Average Poor None

Speaking

Excellent Good Average Poor None

Reading

Excellent Good Average Poor None

Writing

Excellent Good Average Poor None

Have you taken any test of Chinese language

(Yes) Name of the test:
.
(No)

; Scores:

Have you ever taken Chinese Learning Programs/Courses

(Yes) How long have you studied?
()

Where did you study Chinese (high school, college, language institute)?
.

(No)
AUTOBIOGRAPHY

(Please describe your extracurricular activities, academic awards and honors, qualifications,
expertise, teaching and research experience, etc.)
(attach additional pages if necessary)

I certify that I have completed this application form by myself, and that all the information I
have given is true and correct to the best of my knowledge.

The personal data which the student provides will be retained by Office of International
Affairs for the admission and other administrative purposes.

Signature________________________ Date
_____________________