National Chiao Tung University

2014 Summer Program Registration Form

First Name / Last Name / Photo
Nationality / Gender
Birth Date / YYYY/MM/DD / Passport No.
School Name
Major(s)
Undergraduate / □  Freshman □ Sophomore □ Junior □ Senior
Phone No. / Email
Mailing Address
Partner University Student / □  Yes □ No
Modules / NCTU has four Modules. Student should select at least one of them.
1.  Basic Professional Courses
Principles of Communication Systems / □ Join □ Skip
Bioengineering Signals and Systems / □ Join □ Skip
Chemistry with Your Hands / □ Join □ Skip
Mechanical Design and Manufacturing / □ Join □ Skip
Introduction of Life Science / □ Join □ Skip
2.  Mandarin Course / □ Join □ Skip
3.  Management Course
Emerging Competitiveness
(Lecture in Mandarin) / □ Join □ Skip
Emerging Competitiveness
(Lecture in English) / □ Join □ Skip
4.  Culture Courses
Experience Taiwan, Taiwan Experience / □ Join □ Skip
An Introduction to European Culture / □ Join □ Skip
Mandarin Learning Experience / How long have you learned? / □ Never □ Less than a year
□ More than a year
Accommodation
(4 students share 1 room) / □  Yes □ No
If you have special needs, please describe:
______
______
Special Health Condition / □  Yes □ No
Fees / The miscellaneous fee NTD 9,000 is mandatory. The total fee for the 2014 Summer Program is based upon the selected Modules, Accommodation and Miscellaneous. Please fill out the amount. NCTU will help you to check the total payment.
Modules / Fee / Partner University / Non Partner University
Basic Professional Courses / NTD 3,200 / NTD 3,200 / (If you select this module, please fill out NTD 9,600)
Mandarin Course / NTD 3,200 / NTD 3,200 / (If you select this module, please fill out NTD 9,600)
Management Course / NTD 3,200 / NTD 3,200 / (If you select this module, please fill out NTD 9,600)
Culture Courses / NTD 3,200 / NTD 3,200 / (If you select this module, please fill out NTD 9,600)
Accommodation / NTD 6,000 / (If you need the accommodation, please fill out NTD 6,000) / (If you need the accommodation, please fill out NTD 6,000)
Miscellaneous / NTD 9,000 / NTD 9,000 / NTD 9,000
1 Module Total / NTD 18,200 / Please fill out the total / Please fill out the total
2 Modules Total / NTD 21,400 / Please fill out the total / Please fill out the total

Note: Please attach your scanned student ID card when you email the application form.

A confirmation letter will be issued within one week, once NCTU receives your application. The whole registration process will be completed, after received the payment. You are welcome to contact coordinator Ms. Avis Liu either by email: or by phone: +886-3-571-2121 Ext. 50661 for further assistance.