Application Form for a Kainan’s Exchange Student

To a Sister Institution

  1. The application form should be filled up as completely as possible.
    Mark a check  in case of more than one square.
    If you cannot find a proper square for you to check, please name it/them.
  2. The application form indicates an applicant’s personal data to evaluate his/her potentials and abilities and to assess his/her suitability for academic work at a sister institution.
  3. To be attached are (1) transcripts of previous study at KainanUniversity, and

(2) one letter of recommendation.

Family name: / given name(s):
alias:
birthday (month/day/year): / sex: male female
I am a student in the Dept. of ______in the  daytime division  evening division
 freshman  sophomore  junior  senior
I am currently a graduate student  1st year student
 2nd year student but I do not mind studying an undergraduate program.
Language Abilities
I regard my English language skills as  excellent  very good  good  fair
Score in English proficiency test if available: TOEFL: ______IELTS: ______
Do you speak another language?  yes  no
If your answer is yes, what language do you speak? ______
Academic Performances
Average Grade: Freshman: _____ Sophomore: _____ Junior _____ Senior: ______
Graduate program: 1st year ______2nd ______
Honors: 1. Citation(s) ______
2. Award(s) ______
3. Others: ______
Please attach it/them if available.
Favorite subject(s)  language math  music Informationtechnology
computer  others ______
If you choose others, please name it/them.
Extracurricular Performances
I am/was a member of student club(s)  sports philanthropy  writing  debating  others ______
If you choose others, please name it/them.
My role(s) in the student club is/are president  vice-president treasurer  activity organizer studentsenator  section head  others ______
If you choose others, please name it/them.
My personal contribution(s) to class/university  student government  prize winner
 receptionist  class leader  club clerk  others ______
My special skill(s)/technique(s)  organizing magic  editing
 singing  others ______
If you choose others, please name it/them.
My interests & Hobbies  reading  hiking  riding  playing cards  others
If you choose others, please name it/them.
My favorite sports/pastime  baseball  basket ball  shooting  swimming
 track & field  judo  table tennis  others
If you choose others, please name it/them.
State with around 100 words your motives to be an exchange student. / State with around 100 words for what you can/will do as an exchange student.
Permanent address:
Telephone: / Cell phone:
Fax: / E-mailaddress:
I certify that to the best of my knowledge the statements made in this application are complete and true.
date: ______signature: ______

Answers to the questions below are to be written in Chinese only.

person to be notified in case of emergency:
name: / relationship:
address:
telephone:
mobile phone: / e-mail:
fax: