Application Form For ROC Taiwan Scholarship

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The document is an application form for a Taiwan scholarship where the applicant provides personal details and education background. They are applying to study either a Master's or Doctorate at National Cheng Kung University.

The applicant is applying for either a Master Scholarship or Doctoral Scholarship to study at National Cheng Kung University.

In the first year, the applicant plans to attend orientation, learn Mandarin, attend trainings and labs. In the second year, they will work on their thesis while continuing studies. Overall, they plan to abide by rules, respect culture, and achieve academic and personal development.

Application Form for ROC (Taiwan) Taiwan Scholarship

This application form should be TYPED and completed by the applicant. If necessary, additional pages of the same size may be attached.

Please attach a photograph that has been taken within the last 3 months.

Which type of scholarship would you like to apply for?

Master Scholarship Doctoral Scholarship


University/Department plan to attend: NATIONAL CHENG KUNG UNIVERSITY

1. PERSONAL DATA
NAME

SALAZAR
(Last name)

RENATO
(Given Name) (Chinese Name, if applicable)

FATHERS NAME

SALAZAR
(Last name)

FORTUNATO SR.
(Given Name) (Chinese Name, if applicable)

MOTHERS NAME

ULEP
(Last name)

NENA
(Given Name) (Chinese Name, if applicable)
Note: If one or both of your parents were an ROC national at the time of your birth, you are an ROC national as well and therefore not eligible to apply.

NATIONALITY DATE OF BIRTH

FILIPINO
(dd/mm/yy) 28, APRIL 1990 21 BALER, AURORA

Single Married

Female Male

AGE PLACE OF BIRTH CONTACT INFORMATION

PAST RESIDENCE IN TAIWAN

Never Yes, from (dd/mm/yy) to (dd/mm/yy)


Reason for residence: Address: BARANGAY PINGIT, BALER, AURORA

Tel.: Mobile: 0910-3872-175 Fax:

Email: [email protected]
HEALTH CONDITION ANY CHRONIC DISEASES CONTACT PERSON, IN CASE OF EMERGENCY

Excellent Good Fair None Yes. If yes, Please specify.


Name: NENA L. ULEP Email: Relationship: MOTHER Address: BARANGAY PINGIT, BALER, Tel.: Mobile: 0910- AURORA 9282612

2. LANGUAGE PROFICIENCY
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LANGUAGE PROFICIENCY

COMPREHENSION
Excellent

READING
Excellent

WRITING
Fair
Excellent

SPEAKING
Fair
Excellent

Good

Fair

Good

Good

Good

Fair

CHINESE ENGLISH

3. EDUCATIONAL BACKGROUND
Level
Secondary Education Undergraduate Level Education

Name of Institution

Degree Major

Country/City

Period of Enrollment

Baler National High School Aurora State College of Technology (ASCOT) Bachelor of Science in Civil Engineering

Philippines Philippines

2002-2006 2006-2011

Graduate Level Education

4. EMPLOYMENT RECORD
Experience Previous Previous Present Position Company/Organization
Employment Period

Job Training Assistant Engineer Instructor I

Provincial Engineering Office Provincial Engineering Office Aurora State College of Technology

April 2009 June 2009 April 2011 June 2011

to to

January 2012 to Present

5. REFERENCES
Name Eusebio V. Angara Christopher Paladio Position President College Engineer Company Aurora State College Of Technology (ASCOT) Aurora State College Of Technology (ASCOT)
Phone, Mobil, Email, Address

6. PLEASE BRIEFLY STATE YOUR STUDY PLAN WHILE IN TAIWAN On my first year in Taiwan, it is my plan to attend orientation program, learn how to speak Mandarin language, attend different trainings and laboratory works set by the school, study different modules, and also plan for my Thesis On the second year, Ill work with the research process until I finalize my thesis as I continue studying different modules.
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For the whole duration of my stay in Taiwan, it is my plan to abide by their rules and regulations, respect their values and cultures, and achieve academic excellence as well as personality and professional development.

7. DECLARATION: I declare that:


I am neither concurrently an ROC national, nor an overseas compatriot of the ROC; I am not currently undertaking studies in Taiwan for the same educational level as the scholarship type for which I am applying; I am not applying for this scholarship as an exchange student resulting from an agreement signed between my home institution and any Taiwan university/college; The information I have given on this application is complete and accurate to the best of my knowledge.

Applicants Signature

Date

March 3, 2012

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