Name: D8 a- v6 p% A0 b
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/ q! K& Y3 z* a {9 K: W | Gender9 m4 V. s& K0 a" y1 w8 B% C
| □Male □Female
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Passport No." b" T, \: N" Y- s& w0 [ f1 J! `
| " Q+ s) x$ [" [7 i/ K2 H! o
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| Date of Birth; q1 C; a2 H/ c d6 q" O
| Year Month Day
4 y" g* \: k* }. r0 @: L |
Telephone
y5 N) c8 d0 `% d- M ] | (Mobile)1 V: O7 ]0 B+ Q$ Y
| (Home)
. K3 T4 ]9 i* T- [ S | E-mail：/ Z( ?) Q/ h7 C9 f5 I+ }
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Fax
$ @& m- d' S. V4 c5 K& v2 F c | / H/ n6 s2 ^- U' A
| Nationality
* w0 Y; ]. W2 ]; \0 A. x/ S | |
Name of School! K$ l7 y+ O" C M* t, ]% i
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4 H+ A( |' v) S F" }* J! Z- r | Major * a0 x' R# t: K# K; e7 g
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Address
( p9 V0 f# g5 m4 o D, d' N | 4 ?- n, M5 h( m' u0 [6 A4 W
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Eating habits" n9 l5 e' W) \) W
| □Non-vegetarian
2 L; w+ M! `7 J: \7 X$ H( ~$ t□Vegetarian
. {7 l# h& v9 n! h& a# C0 S, \ | Others： Requirements：
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Attending Stage% d& k8 D) k4 d" R9 g
| □ First Stage 7/16（Mon.）~7/17（Tue.）(New Taipei City Hakka Museum )! ]& N7 e) Y! i, ^3 n
□ Second Stage 7/18（Wed）~7/19（Thu.）(New Taipei City Hakka Museum)
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Parents Information
3 o* S9 ]) z. G+ S) a | Name of the parents# S+ J. A# v! o
| □Agree
& X& |, u+ A! y□Disagree
9 Z0 @7 Z! i/ x, t! |9 e
( p2 v" P) n6 v4 ^4 P | Date of Birth; h5 n+ t" m- D9 u
| Year Month Day
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ID No.4 i" }* c0 q4 j, Z
| |
Parents Agreement9 z' ~8 o4 w$ w/ u& S. ^. h
| Signature Date
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Emergency Contact person A" y! w4 u( {
| (Mobile)
* p( p8 F, e9 C4 m) P3 d | (Home)
4 b T: v4 ?5 a/ X | (Work)
* u, A- f2 f8 c* ^7 | | Relationship to Applicant
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Comments | Note: _# F4 L) m) {' p( ^/ H& v
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. . E6 h4 i* d1 x: h" m( P3 }
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發表於 2012-5-21 09:03:55
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