National Chiao Tung University Exchange Student / Visiting Student Application Form

National Chiao Tung University

Exchange Student / Visiting Student Application Form

1. Student Information - please print clearly

First Name：……………………………………………………………………… Last Name：……………………………………………………………………… Sex：□M □F Nationality：………….………………………………… (Photograph) Date of birth：…………Year………… Month………… Date

2. Contact Address - please print clearly

Current address： Apt. No./Street：…………………………………………………………………………. City/Town：………………………………………………………………………………………. State/Province：…………………………………………………………………………………. Country：…………………………………………………………………………………………. Postal/Zip Code：……………………………………………………………………………….. Tel：……………………………………………………………………………………………….. e-mail：…………………………………………………………………………………………….

Permanent address： Apt. No./ Street：…………………………………………………………………………. City/Town：………………………………………………………………………………………. State/Province：…………………………………………………………………………………. Country：…………………………………………………………………………………………. Postal/Zip Code：……………………………………………………………………………….. Tel：……………………………………………………………………………………………….. e-mail：……………………………………………………………………………………………

3. Academic Affiliation and Duration of Stay at NCTU

Field of Study：…………………………………………………………………………………..…….… Duration of Stay：………………………………………………………………………………………….....

4. Language Proficiency

1. Chinese □Excellent □Good □Fair □Poor 2. English □Excellent □Good □Fair □Poor 3. Other …………………………………………………………………………………………………….

5. Educational Background

Educational Institute Department Duration(from/to) 1. Senior High School：.….…………………….. ….…………………… ….…………………… 2. University： .……………………….. .………………………. ….…………………...

6. Permission form Home Institution

Department & Institution：……………………………………………………………….… Name of Advisor:……………………………………………… Signature：……………………………… e-mail：…………………………………………………………………………………………..……

7. Signature of Applicant

Student Signature：………………………………………… Date：………………………………..

8. Instructions

To be enclosed：  Curriculum vitae (CV)  Official Transcript of Records in English  Official recommendation in English  Copy of student’s ID & Passpost Application Timelines： The Spring Semester (of the following year)－ September 1 through October 31 each year； The Autumn Semester－ March 1 through April 30 each year. Admission Office： Office of International Affairs National Chiao Tung University 1001 University Road Hsinchu, Taiwan 30010, R.O.C. Website：http://www.ia.nctu.edu.tw E-Mail: [e-mail] TEL:[phone] FAX:[phone]