University of California Riverside Extension
International Education Programs

請先查閱學校資料，再填表格。因為在您填妥資料後，按送出鈕，您的資料將會被直接
   傳送給學校單位，故請用英文詳細填寫本表格。   Please read the school's information first,
   then fill in this form.  After you fill inthis form and press "Send" button, your information will
   be submitted directly to schools. Hence,  Please fill in this form in English precisely.
Application Form
Personal Details
姓氏
 Family name
名字
 Given names
國籍
 Nationality
生日 (日/月/西元年)
 Date of birth (dd/mm/yy)
性別
 Sex		 Male 男
Female 女
地址 (含郵遞區號與國家)
 Address in home country
(include post code and country)
電話
 Telephone in home country
傳真
 Fax in home country
電子郵件
 E-mail address
Course Selection
Program 請參閱學校課程。   Refer to the School's courses and programs.
欲申請課程名稱
 Preference Course
課程開課日期
(日/月/西元年)
 Commencement date
 (dd/mm/yy)

　

若不確定，請先查詢學校資料。
Check schools' data if unsure. 
Your Accommodation
您需要住宿安排嗎？
 Do you want assistance in obtaining accommodation?		 No      Yes
住宿種類
 What type of accommodation do you need?		 Homestay 住宿家庭      School Residence 學校宿舍
美國停留時間
 Length of stay (weeks)
in USA		 week(s)
您抽煙嗎？
 Do you smoke?		 No      Yes
您需要接機服務嗎？
 Do you require airport pick-up and transfer?		 No
Yes  如果您已經知道自己班機資訊，請回答下列問題。 
             (Answer the following questions if you knew your flight details)
              
Date
Time
Airport
Airline
Flight number
International Student Details
English Language Proficiency
若您接受過任何測驗，請在此填入成績
 Please enter score or grade if you've undertaken any test

TOEFL:   

IELTS:   

Other:   
您的英語口說能力如何？
 Is your verbal English		    Fluent  很流利     Good  好    Fair  還可以   Weak  很弱
您的英語書寫能力如何？
 Is your written English		    Good  好      Fair  還可以    Weak  很弱

  

NOTE：The school reserves the right to vary fees, curriculum and timetables without prior notice.

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