(Please fill in all fields)

1. PERSONAL DATA

Title: Mr./Mrs./Ms.
— Mr. Ms. Mrs.

Last Name:

First Name(s) & Middle Initial:

PLACE OF BIRTH

NATIONALITY

Permanent Address “Parents Home”:

Your Current Mailing Address:

Telephone:

Cell:

E-mail:

Gender:
 Male
 Female

Marital Status:
 Single
 Married

Date of Birth:
Month:

Day:

Year:

Health Condition:
 Excellent
 Good
 Fair

Do You Have Any Chronic Diseases:
 No
 Yes

If yes, please specify:

IN CASE OF EMERGENCY, List the person you wish to be contacted:

Name:

Relationship:

Address:

Telephone:

Cell:

Email:

2. LANGUAGE PROFICIENCY.

Have you studied the Mandarin Language?
 Yes
 No

If yes, please state how long and where you studied. List sites in Taiwan or China where you have received earlier Mandarin education/training.

Class level:
 Beginner
 Novice
 Intermediate
 Advanced

NOTE: Proficiency in the Mandarin language is not required

I will apply for early decision of admission on Feb. 15:
 Yes
 No

3. EDUCATIONAL BACKGROUND.

Undergraduate Level Education

Name of Institution:

Location:

Period of Enrollment:

Graduate Level Education

Name of Institution:

Location:

Period of Enrollment:

4. REFERENCES.


Please provide two references below. Reference letters should be sent to: apply@taiwanusalliance.com

First Reference:
Name & Position:

Business:

Telephone:

Email:

Mailing Address:

Second Reference:

Name & Position:

Business:

Telephone:

Email:

Mailing Address:

5. PREVIOUS EMPLOYMENTS.

a.)Position:

Company/Organization:

Period of Employment:

Responsibilities:

b.)Position:

Company/Organization:

Period of Employment:

Responsibilities:

6. PRESENT STATUS.

a.) Name and Location of College/Univ now Attending:

Please enter cumulative GPA:

Dates of Attendance:

Major, You may also add Special talent:

School Year
Classification (Fr, So, Jr, Sr,):

b.)Department /College/Univ Contact Person

Name:

Address:

Tel:

Fax:

E-mail:

7. PLEASE SUBMIT TWO 300 WORD ESSAYS ON:

a.) WHAT IS THE MOST IMPORTANT THING YOU FEEL THE TUSA EDUCATION COMMITTEE SHOULD KNOW ABOUT YOU?

b.) WHAT ARE YOUR CAREER PLANS AND HOW DID YOU ARRIVE AT THEM?

8. DECLARATION: I declare that:


a. I am not concurrently holding a Taiwan nationality;
b. I am not an exchange student resulting from an agreement signed between my home institution and any Taiwan university/college;
c. The information I have given on this application is complete and accurate to the best of my knowledge.
 Yes

Please type the letters and numbers above.