2014~2015

MTC APPLICATION FORM

* Please TYPE or PRINT in clear Chinese or English. Documents that are not clear will not be considered.
* ()

1-

CHINESE NAME ____________________________

2-

ENGLISH NAME

Last BARRANTES GARCIA_________________________________________________

First _________________________________________________
Middle _______________________________________________
3-

Attach

NATIONALITY ________________________________

4-

Recent Photo

DATE OF BIRTH _____________ Month _________ Day _______ Year

5- SEX

Male

Here

Female

6-

PRESENT OCCUPATION ____________________________________

7-

MAILING ADDRESS

The admissions letter will be mailed to this address, please print clearly in English.

No. and Street

__________________________________________________________________________

City __________________________________________________________________________
State (or Province) __________________________________________________________________________
Country, Postal (Zip) Code __________________________________________________________________________
E-mail __________________________________________________________________________
Phone

_______________________________

Fax ____________________________________

8-
Have you ever studied at this Center before? ( Yes

No)

If yes, what was your student number? -

9- Highest Level of Education

____________________________________________________________

Name of School _______________________________________________________________

Major ______________________________________________________________

2014~2015

10- 1 Please mark the term you would like to begin your studies (mark one term only).

Application Deadline
Visa
Required

No need
for a visa

Fall Term (Sep.1 -Nov. 30)

Jul. 31

Aug. 15

Winter Term (Dec. 1-Feb. 28)

Oct. 15

Nov. 14

Spring Term (Mar. 1-May 31)

Jan. 15

Feb. 11

Application Deadline
Visa
Required

No need
for a visa

Summer Term (Jun. 1-Aug. 31)

Apr. 15

May 18

Summer Session(Jul. 1-Aug. 31)

May 15

Jun. 15

11- Please indicate the source of funds for your study.

Self-financed Supported by parents Bank loan Scholarship (
Scholarship offered by Taiwan government Others (

) Others

12-
Do you have any physical disability or other limitation which requires MTCs assistance?
YesPlease specify _______________________________________________________________________
No
13- Study Motivation Survey
(1) Have you ever studied abroad (short- or long-term studies)?
YesPlease describe this experience briefly.
______________________________________________________________________________________________
No
(2) Please describe the reason(s) you choose to study in Taiwan.
_________________________________________________________________________________________________
_________________________________________________________________________________________________
14-

APPLICATION MATERIALS must include-

MTC application form

Survey of students language background

High school or university diploma (photocopy)

Financial statement showing at least US$2,500 from within the past 3 months

Passport information page (photocopy)

Once submitted, none of these materials can be returned. Diploma and Financial Statement must
be presented in English or Chinese.
Applicant's Signature _________________________

Date _____________________________________

162
Mail to MTC, NTNU, No.162, Heping East Road, Sec.1, Taipei, Taiwan 106

2014~2015

SURVEY OF STUDENTS LANGUAGE BACKGROUND

Name( Chinese________________ ( English________________________________
Native Language_______________________ Nationality___________________________
Education Senior High School

University

Post-graduate

Major:___________________________________
1.
1.2.3...
Your preferred class time (Please list order of preferences starting from 1.)

Regular Course

Intensive Course

08:10~10:00

10:20~13:10 (for current students only)

10:20~12:10 (for current students only)

12:20~14:10

16:20~18:10

14:20~16:10

18:30~20:20

14:20~17:10
17:20~20:20

Regular course students must complete five hours

of supplementary classes every week.

If the class times I choose

above are unavailable, I agree with the class time arranged by MTC for me.
Sign here: _______________________________________________________________________________

MTC will follow your preference as much as possible. However, actual class times are
determined by each terms class availability. If you do not sign on the form, your application may be
rejected by MTC.
2.
Have you ever studied Chinese?

Yes

No

3.
What Chinese study materials have you used ? (Please answer in detail.)

Office use only

(A)

(B)

(C)

____________________________ _________________________________

_______________________________________________________________________________________
___________________________________________________________________________________
1 ____________ __________________________________________________ ( ____________ )
2 ____________ __________________________________________________ ( ____________ )
_______________________________________ ______________________________________

2014~2015
4. When did you study Chinese?____________~__________
5
How long have you studied Chinese?
In my own country:

Where did you learn it? (Please answer in detail.)

_______________
_____hours/per week, for _______years ________months

In ROC (Taiwan):

____________________________ ()

____hours/per week, for_____years _____months at __________________(name of the school)

In PRC:

____________________________()

_____hours/per week, for _____years _____months at ________________(name of the school)

______________ :

_______________

(Please specify it.)

_____hours/per week, for _________years _________months

In total :

_____ years_____ months

( )

Can you speak Chinese?

7

Yes (Fluently Fair A little) No

( 100 500 1000 )
Yes(about below 100 characters 500 characters

Can you read Chinese?

If yes, you can read:

( = ______ hours)

above 1000 characters)

No

standard characters

simplified characters (Check both if applicable.)

(_____)

Can you write Chinese?

Yes (I can write approximately _____characters.)

If yes, you can write:

standard characters

No

()
simplified characters (Check both if applicable.)

9.
Do you ever talk to your family or friends in Chinese? Often
10

Have you lived in a Chinese language environment?

_____ ______

Sometimes

Rarely

Yes No

If yes, how long have you lived there? _____year(s) ______month(s) inTaiwan

11

Have you ever taken a Chinese Proficiency Test?

Never

China Hong Kong

Yes No

If yes, please answer the following questions.

TOCFL (TOP-Huayu)

Certificate__________ When?____________

CPT(in USA)

Score__________________ When?____________

SATII-Chinese

Score__________________ When?____________

TECC

Score__________________ When?____________

Certificate__________ When?____________

HSK

Certificate__________ When?____________