Name
9 z0 X0 ~; Z/ L5 M' S% i% ^" T |
# k; @+ H- ?) ~1 H
9 ^- k& {# q6 j( \0 Z( v | Gender: }8 e# \6 D8 e3 I- k! K% X# t8 a: }
| □Male □Female) a* c$ A( U, A
|
Passport No./ Z+ k: [4 T6 A) o
| 2 G3 I, \4 q5 ^
# z8 ~: g4 H" c( T: N7 h
| Date of Birth# ~3 S% g- u; S/ l0 |
| Year Month Day
5 s8 w4 F4 E* g" e |
Telephone
- u* r( M2 @4 \6 U | (Mobile)2 }/ i8 f) U3 L+ S9 [
| (Home)) M4 h% \, @* O! i
| E-mail：
) \* y4 l# g, E H; e; Q |
Fax
a; K* ~( c5 Q: I4 w$ C3 q- r9 v# P3 N |
/ y' M' v# U; B& _ | Nationality
# U% v l2 v: T* Z, ` | |
Name of School
6 ^ S1 l% j1 B4 M2 p |
# j# F0 R! { a- [$ ~* |" N | Major
7 T% G$ a8 q1 ?$ ^1 M6 H2 U | |
Address
; ]8 }9 E2 J! w- s! B( H+ G | 8 Z: | o' F3 u& F' H
|
Eating habits
* k; X0 g, Z4 M | □Non-vegetarian
( U$ D6 N. W/ _% A: f% L% _□Vegetarian
+ i0 T8 o( i5 e* P; o9 J. ^ | Others： Requirements：
Q# y! \/ X; q& Z& O |
Attending Stage M+ ?5 p! e. d
| □ First Stage 7/16（Mon.）~7/17（Tue.）(New Taipei City Hakka Museum )
. I( L9 k z9 v2 r" }# E0 A□ Second Stage 7/18（Wed）~7/19（Thu.）(New Taipei City Hakka Museum)
4 ?6 \( J( w7 @ |
Parents Information/ Y: a8 h/ ]& p9 R# m6 c% @, x
| Name of the parents* Z; }6 w k+ h3 a0 G. p2 x, @
| □Agree5 e% p1 ~7 O @% l( o' {% z
□Disagree9 |8 y3 `, Y- Z: [7 _8 E8 w
1 N" {2 P- J8 \/ e/ {
| Date of Birth3 s" ^6 E( e+ M
| Year Month Day" |, Q' F, {) d7 H/ A- E2 g
|
ID No.2 X; B3 K$ _. U% G: Y5 b5 p
| |
Parents Agreement: q9 p* _) e5 N& ?
| Signature Date
; S Q! e$ X {, U1 K) s& b* h! r |
Emergency Contact person
9 @. q0 l4 L) f: D- `. m | (Mobile)
% r k( K0 O1 ?, E a1 S | (Home)- h7 O r1 z- j7 { \1 R& N' \
| (Work)! q4 k5 k7 a l0 J; Z7 p
| Relationship to Applicant+ n$ D! o% K$ y; P$ A( h
|
Comments | Note:
( E7 o" U# X8 a7 D1 nPersonal 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. U6 U2 \4 e% l
|
發表於 2012-5-21 09:03:55
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