APPLICATION FOR ADMISSION FOR EXCHANGE STUDENTS

NationalChungHsingUniversity (NCHU)

Taichung, Taiwan, Republic of China

TO THE APPLICANT: Read carefully the notice on the next page before applying. Please type or print.

Proposed academic program: regular exchange program

PartI. Personal details

Full name: (Family /First /Middle name)
Sex: MaleFemale / Date of Birth: ______( month /day /year)
Marital status: single married / Nationality:
E-mail:
Current mailing address:
Number and Street: / ______
City / State: / ______
Zip and Country: / ______
TEL: ______/ FAX: ______
Name of person to contact during emergency:______/ Relationship:______
Address: ______/ TEL:______
Email: ______
Passport information:
Number: ______/ Date of issue:______
Issuing authority:______/ Date of expiration:______
Part II. Program details
Name of Home Institution:
Major area of study:
The year you have completedat your home institution:
-Undergraduate Program:  the 1st year (freshman) the 2nd year (sophomore)  the 3rd year (junior)  the 4thyear (senior)
-Graduate Program: the 1st year the 2nd year  the 3rd year  other:______
-Doctoral Program: the 1st year the 2nd year  the 3rd year  other:______
Which department / college do you intend to enter at NCHU (equivalent or similar to your original major at home institution)?
College: ______Department: ______
Please indicate whether you are applying for one year or one semester of study.
 1 Academic Year (Sept. 2006 - June 2007)  1 Semester (Sept. 2006 - Jan.2007)
Courses Preference:
Please list courses you would like to enroll for the fall semester and the spring semester.
Fall Semester
1.______
2.______
3.______
4.______
5.______
(course name / department ) / Spring Semester
1.______
2.______
3.______
4.______
5.______
(course name / department )
* Students will have to register courses on the Web Registration System when you arrive at NCHU.
Language Proficiency / Excellent / Good / Fair / Poor
Chinese /  /  /  / 
English /  /  /  / 
(other)______/  /  /  / 
(other)______/  /  /  / 

Part III Declaration

I am eligible to apply as an exchange student. I have carefully reviewed all information provided by me pertaining to my application and hereby guarantee their correctness. I understand that should any information be found to be false, my admission to the university will be canceled, and I will be responsible for any consequences that may arise.

Applicant’s signature ______Date ______

Part IV. To be completedby sending institution

We confirm that this student is nominated for exchange student program atNationalChungHsingUniversity.
Name of Institution:______
Name of Office: ______
Number and Street: ______
City/State/Country: ______
Name of Contact Person:______/ Professional Title:______
Telephone: ______/ Fax:______
Email address: ______

Attention toApplicants

◎Applicants are required to submit the following materials as a completed package:

1) A completed application form with photo attached.

2) Certificate of Enrollment issued by the student’s home institution.

3) Official transcript of academic records (translated into Chinese or English) issued by the student’s home institution.

4) Two Letters of recommendation

5) A health certificate (including HIV blood test report)issued by a public hospital within the past six months.

6) A study plan, written in Chinese or English.

7) Autobiography of 300-500 words, written in Chinese or English.

8) Additional relevant materials as may be required by the program you are applying to.

◎Application Deadline:All application materials must be sent by MAY1, 2006.

The application package should be sent to the following address through the international affairs office or other equivalent officeof the home university:

Director,

Division of Academic Development, Office of Research and Development

NationalChungHsingUniversity

250 Kuo Kuang Road, 402 Taichung, Taiwan, R.O.C.

Tel: + 886-4-22840550

Fax: + 886-4-22852787