Name
3 S' A! }+ X3 |3 ^ | ! X: `4 e; k" G; ~, L/ U
4 k! l7 h( i ]2 M- U7 V
| Gender
0 F, L- Z9 A$ H | □Male □Female/ V {# h1 L0 i* k! j- _
|
Passport No.
2 X' ^' }- r& C- F |
( t# g& M" v' k2 {9 C: D( v4 F& h
4 N3 {. W: y. t, F7 ` | Date of Birth
6 F3 e _) d7 e/ b! l# j | Year Month Day
' t: B1 @% l! Q) N K" { |
Telephone
9 U9 f% U) e7 V | (Mobile)
' J1 D8 ]8 w F0 \ | (Home)) l8 I+ G ~2 L l. K
| E-mail：8 d$ j) P, C8 W6 S
|
Fax
3 X1 w' R# ~+ G/ Y! ^ | ) t/ ]0 d, |1 Q8 a( E' i' d
| Nationality* \& E6 p. {! E/ d/ ~2 o& I
| |
Name of School
+ `6 x: C0 ~; Q9 M* K |
/ m0 p% e3 Z. X( j) V% N' D- g | Major - E7 x* Q7 m) c% ]
| |
Address
: j7 O* B$ ^& C) ?9 x9 V% h | ) A8 ~' D+ T* r& a7 A, c6 ?
|
Eating habits
+ O& I2 L$ P5 n' A/ p! J% `9 N) l | □Non-vegetarian 3 S7 S t* p5 n, p! s; y
□Vegetarian! ]% C9 M( N; t2 N% ~ }# D
| Others： Requirements：
6 |- n: P; ~* Q E3 H |
Attending Stage
9 D y6 ]( ~7 f5 U, |0 D | □ First Stage 7/16（Mon.）~7/17（Tue.）(New Taipei City Hakka Museum )& b* S! `/ [" W" ~9 K2 u
□ Second Stage 7/18（Wed）~7/19（Thu.）(New Taipei City Hakka Museum)
0 }8 ^! s: Q0 o* G& a; v. I1 [8 ?* t |
Parents Information
9 q' ?1 m! i/ Y+ T$ K3 w | Name of the parents* i5 d( j$ o+ Z; x* K
| □Agree4 l/ j0 O7 _. M
□Disagree9 f# v( z x4 [; U2 O: c$ Z
7 q( x$ g( \' i- c' o$ N# A4 `! ^, t
| Date of Birth
! Z! L( [0 u) E5 N+ i ~ | Year Month Day
& }& ^6 k( ?" @5 `* ~% b; w0 g |
ID No.4 _. o/ E+ V, t- L, s3 B. x. x
| |
Parents Agreement
( T* ?4 f/ i" t3 F. O | Signature Date
1 f% _% y n4 s5 { |
Emergency Contact person
5 A7 @( w4 c& g, P! M# d | (Mobile)
; r, H. p4 d- c1 K6 Q | (Home)
" \9 [4 k, x% \3 R: ^7 r! z! g, _$ ^ | (Work)0 F; V; N- X" ^5 H6 p6 {* w/ `$ \+ c1 c
| Relationship to Applicant
" Q; t# W" m$ s o: L. I |
Comments | Note:
2 S& M; X: q' p' T+ l& 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. , C9 }8 {9 V7 \' M$ g
|
發表於 2012-5-21 09:03:55
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