Application Form

| | First (given) Middle Last (family) |Nationality | |
|Name | | | |
|(same as on passport) | | | |
| Chinese Name | | | |
|Level of Chinese |□ fluent | Passport or ARC # | | |□ Male |
|speaking |□ average | | |Gender |□ Female |
| |□ a little | | | | |
| |□ none | | | | |
| | |Cell Phone# | | | |
| | |Birthday(YYYY/MM/DD) | / / | | |
| | | | |Religion | |
| | |If you are under 20 yrs old, please write down your father or mother’s | | |
| | |name:_______________________ | | |
|E-mail | |
|Allergies |□ No □ Yes |
|Dietary Restrictions |□ No □ Yes |
|Special Requests |□ No □ Yes |
|To participant: |
|In this activity, you will be partnered with one host family; you will enjoy one-day activity with them and experience local culture at the same time. |
|Participation in this activity needs to be approved of by the representative from your university or college; please ask them to sign and stamp your application |
|as below. |
|You are in charge of any extra costs, such as transportation costs from your living place to the Taoyuan Train Station, personal expenses, etc. |
|Smoking is discouraged; if you must smoke, it is only permitted in smoking areas. |
|Please respect your host family; we hope you can become an integral part of the family. |
|The Taiwan Hostfamily Program is not responsible or liable for any actions of the host family. |
| |
|I fully understand the above-mentioned rules and conditions, and I promise that all information I have provided is correct. Further, I hereby agree that all |
|photos of me taken during this activity can be used by the Taiwan Hostfamily Program. ___________________(Applicant signature) |
|To the university or college: |
|We will match one host family with this student during this activity; they will stay together and establish a friendship for further interaction and meeting; |
|therefore, the staff at your institution is hereby notified that your international student may possibly have further contact with this family in the future, so |
|that you might be able to provide timely assistance while participating in their host family’s future activities. Thanks for your cooperation! |
|重要相關訊息: |
|計畫辦公室將於活動當天為國際學生與接待家庭舉辦媒合會，讓彼此認識及進一步相處，以利日後在臺研習期間持續與接待家庭互動，特此先行知會貴校，以方便日後了解學生狀況及未|
|來協助國際學生參與各項接待家庭活動，謝謝! |
| |
|University or college’s name & Dept. : |
| |
|Office staff: ________________ (Signature) (Seal of the office) |
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λ Note: Please fill your application form completely and email it to hostfamily@mail.stust.edu.tw. before April 11.