Chung Hua University

APPLICATION FORM

(Please complete in block letters)

Personal Details:
Title: ______ Surname/Family Name:________________ First Name:
___________________
Date of Birth: Day Month Year_______ Male/Female: ____ Native Language:
__________
Nationality: _______________Country of Permanent Residence: _____________________
Passport Number: ___________________
Contact Details:
Address for
Correspondence:_________________________________________________________
__________________________________________________________________________
Permanent Address (if different from
above ):___________________________________________
__________________________________________________________________________
Telephone Number:_____________________ Fax Number:___________________________
Country Code/Area Code/Phone Country Code/Area Code/Phone

Email: __________________________
Emergency Contact: Name:_______________________
Relationship:__________________
Telephone Number: _________________________
Study Details:
Your Proposed Date of Entry: Month: ______ Year: ________
Study Program: □ Ph.D. □ Master □ Bachelor □ Mandarin
Research Interest:_______________________
Department/ College:________________________

Educational History:
Dates Attended Name of Grades Achieved Degree and
Institution Subject

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Working Experience:
Dates Post Name of Duties
Organization

Are you physically sound and well? ( □ Yes or □ No).

If not, please describe your status with respect to any
disability:___________________________

Financial Statement: Please describe how your fees and expenses will be
financed.

References (for graduate programs only):

Referee 1: Title:________________________________
Name:______________________________
Address:__________________________________________________________________
TEL: __________________ Fax: ___________________ Email: ____________________
Referee 2: Title:________________________________
Name:______________________________

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Address: _________________________________________________________________
TEL: __________________ Fax: ___________________ Email: ____________________

Supporting Documents:
Transcript of Qualification: □ Enclosed □ To Be Followed
Financial Statement: □ Enclosed □ To Be Followed
Two Reference Letters: □ Enclosed □ To Be Followed
Study Plan: □ Enclosed □ To Be Followed
Health Certificate: □ Enclosed □ To Be Followed

I declare that the information on this form is true and agree

to abide by all of the University’s regulations if registering
as a Chung Hua student.
Applicant’s Signature: _____________________Date:
________________

For More Information:

The Office of International Programs, Chung Hua University,
No. 707, Sec.2, Wu Fu Rd., Hsin Chu Taiwan 30012
TEL: 886-3-5186176, FAX: 886-3-5186174
www.chu.edu.tw ; email: international@chu.edu.tw

Office Use Only:

Department / College:

Registry:

REMARKS
Qualifications:

1. Applicants must be a graduate or an undergraduate from accredited universities,

colleges or senior high schools;
2. If the applicants carry both Overseas Chinese Students and foreign nationality
status, the applicants must make a choice between them. The admission will be
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 revoked immediately if they are found to have applied according to both statuses.

Required Documents:

1. A completed Application Form.

2. One copy of the Passport.
3. Financial Statement: issued by scholarship documents or a bank statement,
showing the applicant is able to cover all the expenses needed when attending the
program.
4. Four Photos (1〞* 1.5〞).
5. A report of the Health Certificate (including HIV and lung X-ray test).
6. One copy of the highest Educational Diploma with notarized English translation.
The Diploma has to be authenticated by the local Taiwan Representative Office.
(for degree programs only).
7. One copy of the Academic Records with notarized English translation. (for degree
programs only)
8. A Study Plan (for degree programs only).
9. Two Reference Letters (for graduate programs only).