ACUCA 線上微學位/證書課程報名表單| ACUCA MDP Application Form

2025 Winter MDP Course Registration

中文姓名 Chinese Name

外籍生可不填寫
Optional for foreign students
英文姓名 English Name *

需與護照相同(全部字母大寫)
Should be identical to the passport (All in capital letters)
學號 Student ID *
手機號碼 Cell Phone Number *

請依照以下格式填寫 Please follow this format 09XXXXXXXX
Email *

請提供最常用Email以免遺漏訊息 Please provide the most often used email to prevent missing message
性別 Gender *

性別 Gender 男 Male 女 Female 非二元 Non-binary
出生年月日 Date of Birth * / 月 / 日西元年
學制 Type of Degree *

學制 Type of Degree 日間學士班 Regular Bachelor 進修學士班 Bachelor of Continuing Education 碩士班 Master 博士班 PhD
學系/學位學程 Department/Program *
就讀年級 Year of Study *
身分別 Enrollment Status *

身分別 Enrollment Status 本地生 Local Student 外國學生 Foreign Student 僑生 Overseas Chinese Student 陸生 Mainland Chinese Student
申請學程時段 Apply Program Period *

申請學程時段 Apply Program Period 夏季 Summer 冬季 Winter
申請活動名稱/Name of the Applying Program *

請填寫申請之活動名稱 Please fill in the name of program you wish to apply
母語為中文
Native language is Chinese/Mandarin *

母語為中文
Native language is Chinese/Mandarin 是 Yes 否 No
在學期間已完成的交換學習
Completed Outbound Exchange Study *

在學期間已完成的交換學習
Completed Outbound Exchange Study 從未交換 None 一學期 One Semester 一學年 One Year
申請學程(最多兩堂課)
Apply course(s) (maximum two classes) *
A. AI Ethics and Christian Leadership B. Cross-Cultural Management in ASEAN C. Forgiveness and Reconciliation: Psychological and Christian Approaches D. GEN Z CAN LEAD (Equipping Gen Z with Gospel-Centered Leadership) E. Social Entrepreneurship: Creating Positive Imapcat through Innovation
申請學程(最多兩堂課)
(maximum two classes)
選兩堂課的同學請註明課程選取的優先順序，例如：C>A
For students who choose two courses, please indicate the priority of course selection, ex: C>A *
請上傳規定之申請文件 Please upload the following documents to complete the application
護照影本 Photocopy of Passport (非兩岸地區活動) *

附加檔案附加檔案
歷年成績單影本 Official Transcript for all semesters *

附加檔案附加檔案
緊急聯絡人姓名
Emergency Contact Person Name *
緊急聯絡人關係
Relation with Emergency Contact Person *
緊急連絡電話
Emergency Contact Phone Number *
本人同意報名所填各項資料，由貴校依據「個人資料保護法」等相關法令規定，為必要之資訊應用，處理相關事宜。
I hereby confirm all registration information to be used for handling the relevant matters as the required application information by the school according to the pertinent regulation of the “Personal Information Protection Act”.
是 YES
本人同意以上所填各項資料若有不實，國際暨兩岸合作處得取消本人申請本次赴全球姊妹校參加短期研習活動之資格。
I hereby confirm that the Office of International Relations reserves the right to decline my outbound short-term program application if any information provided is incorrect.
是 YES

ACUCA 線上微學位/證書課程報名表單| ACUCA MDP Application Form

ACUCA 線上微學位/證書課程報名表單| ACUCA MDP Application Form

請上傳規定之申請文件 Please upload the following documents to complete the application