Name
' S1 f7 w y/ a! X |
$ k8 l! c. {) G
) i! N- x7 D; {9 \ | Gender
7 N, L7 s3 j" Q# N5 m) F$ H | □Male □Female
9 d4 j5 v3 F6 N; z1 Z! [% N |
Passport No.
; M% N# k; V0 Y# K* P' B | / _2 B$ Z) l+ E
$ {6 y4 U5 t1 n3 @/ O | Date of Birth; t' D# h0 K& [8 k* o% u, P' ^2 ^7 a
| Year Month Day+ i0 Q3 D& L. P! {
|
Telephone 7 Y) D- z% r3 y6 V
| (Mobile)! {6 b/ G$ a' ^3 E
| (Home)8 |/ Z& ], g* u4 j& V
| E-mail：
+ _& K) B! d' i1 e m$ H |
Fax ) c4 r6 W: [5 W* q! P) [! @
| 4 @- F% g6 j( r, q9 t3 F6 s7 ^' B
| Nationality
9 T `% S' B( h+ J | |
Name of School( ?! U. Z+ r3 z7 o, P
| $ x' D1 B+ s6 T, M2 S
| Major
" e" Q! D/ H7 R) S | |
Address
' N' O+ B; O$ h8 Q" K |
9 ]# C4 D1 d8 O$ { |
Eating habits
+ R+ B( M+ s& q8 E( N% Y6 F | □Non-vegetarian 0 V* l6 ^: \* F$ ~4 v
□Vegetarian( O! b% b0 m* i5 H0 c2 a
| Others： Requirements：
: A2 k) g7 i; k" i- ] |
Attending Stage
9 o! n+ A5 [& z N2 I | □ First Stage 7/16（Mon.）~7/17（Tue.）(New Taipei City Hakka Museum )( M2 u2 F3 C: I6 s/ v
□ Second Stage 7/18（Wed）~7/19（Thu.）(New Taipei City Hakka Museum)
) y3 }0 q! W* W# b; Q |
Parents Information
: {# q6 ~3 \8 @) D) V/ [/ o | Name of the parents
. m/ x6 Q k5 E5 I9 @# H, U | □Agree( h7 ]2 C3 s }! @4 }- d
□Disagree0 B6 q m2 b( y0 o$ ]% E
" e( O+ V: w2 J" a+ V
| Date of Birth
! C- b* D5 W: }8 C" k" \ | Year Month Day
2 q; [# p' }1 u, r/ ^8 Z8 D2 M4 M |
ID No.# J$ p2 A% s+ h0 r
| |
Parents Agreement8 _3 n- u" k# c* b
| Signature Date" T7 H$ A8 |4 X: Q/ [3 k) `
|
Emergency Contact person1 |% c, h" ^+ q/ x0 ^
| (Mobile)4 P( {0 s! B# O, B
| (Home)
* U1 V) r( ?0 v) b | (Work)+ @8 V5 O; I _3 c4 O/ {' V
| Relationship to Applicant9 Q h( q. b% _& x, M9 p+ b" G, w0 w
|
Comments | Note: & W( \" ?0 e+ d% j6 [, ^
Personal 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. |" o* Q5 M! F9 R' T
|
發表於 2012-5-21 09:03:55
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