個人資料 My Information
Application Number (For Office Use): 1131270048
銘傳大學外國學生入學申請
Ming Chuan University International Student Application
*Please type or print clearly in ink. This application will not be processed if not complete.
1. Name(as it appears on your passport) 中文姓名
口Mr. 口Mrs. ˇMiss Đỗ Hiền Minh
Last (family) First (given) Middle
2. 性別 Gender 口Male ˇFemale 3. 生日 Date of Birth 2/23/2006 month/date/year
4. 出生地 Birth Country Vietnam 5. 國籍 Nationality 越南 Vietnam
6. 護照號碼 Passport No. P00233790 7. 婚姻狀況 Marital Status ˇSingle 口Married
切結書 Deposition
請詳細閱讀並逐一確認 Please read it carefully and tick all boxes that apply
ˇ 1. I hereby certify that I do not possess the nationality status from the Republic of China and have never held household
registration in Taiwan since my birth. 本人保證不具中華民國國籍且自始未曾在台灣設有戶籍。
ˇ 2. I hereby certify that I do not possess an overseas Chinese student status or Hong Kong/Macau resident status and have never
previously applied to colleges/universities with the above-mentioned statuses in Taiwan.
本人保證不具僑生或港、澳永久居民身份且在台並未以僑生或港、澳生身份申請大學校院。
ˇ 3. I hereby certify that the certificates of the highest-level diploma I provide are valid and authentic from my school, and they
are equivalent to the degree level that universities/institutes offer in the Republic of China. 本人所提供之最高學歷畢業證書在
畢業學校所在國家均為合法有效取得畢業資格，並所持之證件相當於中華民國國內之各級合法學校授予學位。
ˇ 4. I hereby certify that I have not finished high school programs in Taiwan with international student status (excluding schools
that enroll foreign residents in Taiwan or bilingual programs affiliated with local high schools), or ever dropped out/withdrew
form colleges/universities in Taiwan due to behavior issues, poor academic performance or a conviction under the Criminal
Code. 本人不曾在台以外國學生身份完成高中學校學程(外國僑民學校或台灣高中附設之雙語部/班不在此限制)，或未曾因操行、
學業成績不及格或因犯刑事案件經判刑確定致遭國內大學校院退學。
ˇ 5. I hereby authorize Ming Chuan University to verify any information provided above. I am willing to follow the rules and
regulations of Ming Chuan University without any objections should the information provided be found untruthful.
上述所陳之任一事項同意授權 貴校查證，如有不實或不符規定等情事屬實者，本人願依貴校相關規定辦理，絕無異議。
簽名欄 Signature
DO NOT TYPE, Applicant must sign in person, same as your passport signature.
請申請人親筆簽名，並與護照簽名相同；不接受電腦打字
申請人簽名 Signed by ____________________________ 日期 Date ____________________
1/1
Powered by TCPDF (www.tcpdf.org)
