Name5 a- h9 W6 D! A0 r& u7 B
|
, K9 c2 U5 F0 N* W/ L- v
) q+ K' ~% |: ?8 { | Gender% w1 m! u$ `! `+ q; B
| □Male □Female
3 n% k& I& Z6 q# j% A" E |
Passport No. {( z/ u" r- x$ M$ y- N; o+ p% c+ B
|
# P3 W3 L4 K2 E3 ] d: v ' T% h8 J- p' n2 O
| Date of Birth
1 ^3 J7 f+ T1 o' V" t# W | Year Month Day9 `- D) F+ c, d5 ^( w
|
Telephone
4 ~2 K* u; G6 O$ X; _$ f0 z, [, i* p5 \ | (Mobile)% r% q0 |8 N0 i" {$ e K3 j, K: n6 u
| (Home)9 u- l! @3 Z/ S, m
| E-mail：: X S8 j5 r5 G' Q5 h2 d- W4 k
|
Fax
" M+ x) ^ x$ ^. b( v | 9 | e+ N. B6 ]9 C- W6 A" r2 o4 ]
| Nationality5 _8 @# G( p, C" l
| |
Name of School
/ h+ X5 j7 e' j' H% @ |
! w" b) r0 W% s1 n | Major / o% B( ?/ b, O/ ~/ |
| |
Address
( c8 U T/ ~4 N) A7 ^: ? | 0 w$ j5 [( x1 M" S" \
|
Eating habits
7 U6 Q# z& e @9 Q9 _ | □Non-vegetarian
. Y5 d! m* ?% y# y# ~/ L" `□Vegetarian
+ J; G: y- G0 } | Others： Requirements：
6 Z) Q: s+ Z6 W0 G6 i( r |
Attending Stage
J/ G. Q7 C4 E' B1 R$ U* w | □ First Stage 7/16（Mon.）~7/17（Tue.）(New Taipei City Hakka Museum )8 B3 ]4 \0 V4 n( o4 c
□ Second Stage 7/18（Wed）~7/19（Thu.）(New Taipei City Hakka Museum)
7 G- H- {; \* T% f1 S1 H |
Parents Information+ h# I8 H$ N# b9 `+ y* Y9 D. X
| Name of the parents* E9 ]7 V1 C* V3 }3 v, Q1 @; X
| □Agree
8 G" l' l: L l) X9 W2 _□Disagree8 k' m+ _& h' m
5 C+ s6 A: M7 ^ | Date of Birth8 w8 I9 B# x+ j0 [0 _6 |
| Year Month Day1 B/ w( ?- F3 {
|
ID No.
! j$ w. n& w+ ?/ c' y4 c9 Z | |
Parents Agreement! D( w9 @4 G( q2 N6 h0 C2 P
| Signature Date! y3 i0 r( y' r8 }3 `
|
Emergency Contact person: R Y* ]& M: F# b' K9 L
| (Mobile)5 c1 s* S6 T% T' L( I& P# D* d- ]
| (Home) e% W4 w; i e- r* { I0 w" V2 Q1 ]
| (Work)2 v! \. X4 p9 _2 g x% A
| Relationship to Applicant# w% I% G3 ~) b0 \9 Z8 m% l
|
Comments | Note:
: ?" t& m4 |+ Q" DPersonal Belongings: Sleeping bag or quilt , Toilet articles (Tooth cup, Toothbrush, Toothpaste, Towel), Clothing, Slippers, Coat, Umbrella, Healthy insurance card, Personal medications and a good mood.
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發表於 2012-5-21 09:03:55
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