I-SHOU UNIVERSITY


APPLICATION FORM FOR THE SCHOOL OF MEDICINE FOR INTERNATIONAL STUDENTS


I-Shou University

No.8, Yida Rd., Jiaosu Village, Yanchao District,

Kaohsiung City 82445, Taiwan R.O.C.

2013 Fall Semester (Beginning in September)
Department/ Institute / Department/Institute: School of Medicine for International Students
A program taught in English

Personal Information

Applicant’s Full Name / (English) / Date of Birth / dd / mm / yyyy
(Chinese) / Gender / □ Male
□ Female
Address
Mailing Address
E-mail
(Required)
Telephone / +Country-Code-Number / Mobile / +Country-Number / Passport No.
Place of Birth / Does your home country have diplomatic relations with Taiwan? / Yes, my home country is: / (please specify)
No, my home country is: / (1)
(2) If any
Father / Full Name: (Chinese or English) / Mother / Full Name: (Chinese or English)
Nationality:
Place of Birth:
□Never possessed Chinese nationality. / Nationality:
Place of Birth:
□Never possessed Chinese nationality .
Telephone: / Telephone:
Contact in Taiwan / Full Name: (Chinese or English) / Relationship: / Telephone:
Mailing Address in Taiwan:

Educational Background

University/
College / Name of Institution
Duration of Study / From: (mm/yyyy)
To: / Degree
Country / Major / GPA/Highest Possible Grade / /
Graduate
School / Name of Institution
Duration of Study / From: (mm/yyyy)
To: / Degree
Country / Major / GPA/Highest Possible Grade / /

Financial Supports: What is your major financial resource while you are studying at ISU?

□Parental Support
(in NT$ or US$)
□Personal Savings
(in NT$, or US$) / □Others
(in NT$ or US$)

Are you applying for a scholarship?

□No □Yes (Please fill out the ICDF Higher Education Scholarship Application Form)

Health Status

□ Good □Average □Poor
Please specify if you have any current health concerns:

How did you know about us?

□Newspaper: □Internet Search □Magazines □From a Friend
□From an Organization: □Other:

Chinese Proficiency

How long have you learned Chinese? / □I have never learned Chinese
□From to
If so, where did you learn Chinese?
(e.g. a high school, college or language institution)
Have you ever taken any Chinese proficiency test? / □Yes
□No / Test Title / Score
Self-evaluation of Chinese Proficiency
Listening / □Excellent / □Good / □Average / □Poor
Speaking / □Excellent / □Good / □Average / □Poor
Reading / □Excellent / □Good / □Average / □Poor
Writing / □Excellent / □Good / □Average / □Poor
□I cannot take courses taught in Chinese.
□I can take courses taught in Chinese, but I shall take additional Chinese courses to improve my Chinese.
□I can take courses taught in Chinese, and there is no need for me to take additional Chinese courses.

English Proficiency

How long have you learned English? / □I have never learned English
□From to
Where did you learn English
(e.g. a high school, college or language institution)
Have you ever taken any English proficiency test? / □Yes
□No / Test Title / Score
Self-evaluation of English Proficiency
Listening / □Excellent / □Good / □Average / □Poor
Speaking / □Excellent / □Good / □Average / □Poor
Reading / □Excellent / □Good / □Average / □Poor
Writing / □Excellent / □Good / □Average / □Poor
□I cannot take courses taught in English.
□I can take courses taught in English, but I shall take additional English courses to improve my English.
□I can take courses taught in English, and there is no need for me to take additional English courses.

I-Shou University

Affidavit for the School of Medicine for International Students Application

I hereby authorize I-Shou University to verify the information provided below. If any deception, concealment, violation or forgery is found, I have no objection to being disqualified from admission to ISU and my student status will be revoked, and no proof of attendance or diploma will be issued.
Signature: Date:
I hereby certify the information provided below
  1. Nationality and residence
I am neither an overseas compatriot student nor an R.O.C. national as defined in Article 2 of the Nationality Act*, and I never possess a Chinese nationality or a citizenship of Hong Kong or Macau at the time of application.
  1. The highest degree submitted by me (a bachelor degree or above) is valid and has been awarded legally in the country where I graduated. The diploma submitted by me is comparable to that awarded by accredited institutions in Taiwan.
  2. All the documents provided by me (including the application form, the diploma, passport and other relevant documents, original or photocopy) are valid. Should any document be found to be invalid or false, my admission to ISU will be revoked, and no proof of attendance will be issued.
  3. Once admitted, I must present the original of the diploma and transcripts officially authenticated by the R.O.C. overseas office or representative office in the country where the school is located at the time of registration. If I fail to submit required documents or any of the documents submitted does not meet the provisions of the Regulations Regarding the Assessment and Recognition of Foreign Academic Credentials for Institutions of Higher Education of the Ministry of Education, R.O.C., ISU reserves the right to disqualify me from being admitted to the University.
  4. The University shall handle applicants’ personal information pursuant to the Personal Information Protection Act enforced by the R.O.C. government, and applicants’ personal information shall be used for student recruitment purposes and relevant statistical analyses only. The personal information of enrolled students shall be used for student enrollment purposes only.
  5. Students shall return to their home countries after graduation and completing the clinical internship, and they are not allowed to take the medical license examination or conduct medical practice in Taiwan.
＊Note：
According to Article 2 of the Nationality Act, a person shall have the nationality of the Republic of China under any of the conditions provided by the following subparagraphs:
  1. His/her father or mother was a national of the Republic of China 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 Republic of China at the time of death.
  3. He/she was born in the territory of the Republic of China, and his/her parents can’t be ascertained or both were stateless persons.
  4. He/she has undergone the nationalization process.
Preceding Subparagraph 1 and Subparagraph 2 shall also apply to the persons who were minors at the time of the amendment and promulgation of this Act.



Academic Certificate Declaration

*Please submit the declaration, the application form and documents for application review to the Admissions Section of the University via fax, e-mail or uploading.

The academic certificate issued by ______as a BA/MA diploma (or equivalent documents) is approved by the R.O.C. Ministry of Education. The undersigned guarantees that the following authenticated diploma, certificates, and/or the authenticated official complete transcript of record will be handed over upon registration:

  1. The copy of the certificate of a bachelor degree certified by a local R.O.C. embassy, a local R.O.C. overseas office or a R.O.C. representative office (A notarized Chinese translation shall be provided as well).
  2. The original copy of the academic transcript certified by a local R.O.C. embassy, a local R.O.C. overseas office or a R.O.C. representative office (A notarized Chinese translation shall be provided as well).

If the related certificates cannot be submitted on time, or they are found to be untrue or unacceptable in accordance with the Regulations Regarding the Assessment and Recognition of Foreign Academic Credentials for Institutions of Higher Education promulgated by the R.O.C. Ministry of Education, the under-signee shall be denied admission.

State/Country of School Where Applicant Graduated
Name of School and Department Where Applicant Graduated (in foreign language)
Period of Study / From to
(YYYY/MM/DD) (YYYY/MM/DD)
Department Applied / School of Medicine for International Students / Serial No. / (To be completed by the University)
Signature of Applicant / Passport No.
Contact Number / Home:
Mobile:
Mailing Address

Date: MM DD, 2013

I-Shou University

Checklist of Documents

* Full name: (English)：

* Full name: (Chinese)：

Please check the items that you have submitted ()

check() / Documents Required for Application / Quantity
The following documents are required for all applicants:
An Application Form / 1
A photocopy of the passport or the proof of nationality / 1
A photocopy of the diploma in English or Chinese / 1
An official transcript in English or Chinese / 1
Certificate of completing at least 6 credits of courses relevant to biology, chemistry or list sciences / 1
English Proficiency Certificate
Test Title： / 1
An autobiography in English / 1
Letter of recommendation / 3
Transcript of the medical school admission test (MCAT, BMAT or GAMSAT) taken within 3 years / 1
Practical experiences in medical practice and laboratories / 1
Volunteer service experiences / 1
Other:
Other:
Other:
Note: Applicants must submit an original copy of the Health Report issued by a hospital (including HIV test results, Measles and Rubella Antibody Positive Report or certification of prophylaxis inoculation; please only use the form attached herewith) to the local R.O.C. embassy or the local R.O.C. overseas office when applying for their student visa for entry to Taiwan, as well as to the Health Section of the University at the time of registration.