长期交换英文申请书填写说明

1、長期交換英文申請書填寫說明前言：這份英文申請書將送至國外給你的接待地區，接待社與接待家庭，他們將依據申請書的內容來瞭解你，甚至因此決定是否接待你，為了讓他們對你有良好的第一印象申請書內容詳細、整潔是必要的，請詳讀所有注意事項後，仔細填寫以期跨出順利的第一步！A、 一般注意事項（General Instructions）1、 字體務必清晰易讀並以印刷體或電腦打字填寫，完整回答每一個問題，不可簡略（如：同上、或如第幾頁回答）。2、 每個答案必須寫在指定的位置，因此建議先寫一份草稿，確定無誤後再重寫正式的申請書。n 簽名（Signature）1、 所有簽名必須保留原始筆跡（不可COPY）且請用藍色墨

2、水。2、先填寫完整一份申請書，但簽名處保留空白，再COPY三份， 然後相關人員分別在四份申請書上簽名。3、每份申請書上學生有五個簽名處，父母或法定監護人有三個簽名處。4、每個必要簽名的地方都有”符號。5、醫科與牙科檢查結果原稿先COPY成三份，連同原稿四份再分別給醫師與牙科醫師簽名。6、第9頁保證書見證人（Witness）一欄請派遣社社長簽名。n 日期（Dates）相關日期標示依國際慣例以年、月、日順序，且月份以英文字母縮寫，如：2003/Dec/21n 照片（Photographs）1、四份申請書必須張貼原版照片或彩色COPY照片。2、每份申請書須要半身脫帽兩吋照片一張，貼於申請書第1頁，四

3、張生活照貼於申請書第8頁。3、照片必須用雙面膠或膠水黏貼，禁用訂書針。n 電話或傳真（Telephone Numbers）電話或傳真號碼必須包括：國碼、區域號碼。如：886-2-23703322n 其它（Other） 1、申請者之英文名字必須與護照上所登記者相同，以免造成簽證 困擾。 2、請準備英文自傳並加強青少年交換計畫（YEP）的抱負與校長推薦函一式四份。3、若有其他問題，則請教扶輪社顧問，學校老師或地區青少年交換委員會。4、請於2星期內將所有資料準備齊全連同文申請書一式四份送交地區青少年委員會。國際扶輪第3480地區 Rotary International District 3480

4、4F,NO.67 Pao-Chin Rd.,Taipei,TaiwanTEL：886-2-23703322 FAX：886-2-23707776e-mail：r3480yepChairperson：PP Water Chen（Hsiu-Chin Chen）B、特別指示事項（Specific Instructions）：n 第一頁：1、 父母或法定監護人（Applicant and Parents legal guardian）：親生父母或法定監護人資料務必完整，即使父母離婚，仍然必須徵詢未擁有監護權之一方同意，除非當事者被領養，或繼父母擁有監護權，其緊急連絡電話不可與公司或家裡電話相同，且確保

5、能聯絡到父母本人，若有傳真或e-mail也請提供。2、 生日（Date of Birth）：申請者生日請務必與護照所載相同，並以國際標準模式書寫，如：2003/Dec/213、 扶輪社與地區背書（Rotary Club and District Endorsement）：申請書填寫完成一式四份，請扶輪社秘書、社長簽名後送至地區請地區青少年交換委員會主委簽名。n 第二頁：學校與各人資料（Secondary school and Personal Information）：1、 上學年數計算不包含幼稚園2、 為使你在交換期間能被安排在適當的班級就讀，申請書中請附上最近兩年的成績單，成績單內容必須包

6、含所學所有學科，且必須翻成英文版。3、 若申請者有學習外語，請依個人評估，告知申請者之外語能力。4、 若申請者有抽煙、飲酒甚至嗑藥請據實回答，此舉並不表示申請者一定被拒絕交換，只是接待家庭的安排必須作特別考量與分配。5、 有關學校校長、顧問或指導老師報告部份，建議申請者找本身所就讀之學校校長、顧問、指導老師、教育長或服務於其他學校之教學管理權威，且對申請者有充分瞭解者填寫，切勿隨便找一個老師草草完成報告。n 第三五頁：醫科與牙科檢查（體檢）（Medical and Dental Examinations）1、 申請者體檢必須於地區甄試之前完成並於甄試時示出檢查結果。2、 體檢必須具有執照之合格

7、醫師執行且該醫師不得為申請者家庭之成員。3、 請體檢醫師詳實填寫表中所列之各項問題，以便接待地區充份瞭解申請者之健康狀況。4、 切記！務必做有關肺結核檢查務n 第五頁：醫療許可與讓渡（Permission for Medical Care and Release of Medical Records and Liability）1、申請者與親生父母或法定監護人簽名同意，接待家庭、接待社在緊急情況代替申請者之親生父母或法定監護人決定接受必要之醫療照顧，並承擔一切相關費用。2、緊急聯絡人必須是申請者之家庭成員或其父母之親信友人，必要時能夠代替申請者之父母或法定監護人決定申請者相關必要之醫療處置。n

8、 第七頁：補充資料（Supplemental Information）1、 請完成接待社與接待地區之通訊資料2、 申請者若有飲食禁忌，請明列並闡述其原因；如：基於宗教、各人喜惡或醫療因素。3、 詳盡的回答每一個問題，但答案以不超過三頁為原則，請表現申請者的特質與思想，因為這是申請者與接待社以及接待家庭溝通的開始。4、 注意回答問題的言詞，不宜太粗俗也不必過於艱澀，文法與拼字講求正確、文章條理分明，以期給對方良好的第一印象。5、 請參考”Supplemental Information中英對照”將讓你更精確回答問題。n 第八頁：照片（Picture Page）1、 照片可使用彩色COPY或原版沖

9、洗四份，切勿使用糢糊或淩亂的照片，那將表示申請者準備不夠充裕。2、 My Family 部份請選擇包含家庭成員的照片。Special Interest 部份請用申請者從事其所喜愛之嗜好或活動之照片。Something Important to me 部份秀出申請者的寵物、好友.。3、 必要時可在照片下方做文字說明。n 第九頁：保證書（Guarantee form）1、 保證書乃申請簽證必要文件之一。2、 由請者與親生父母或法定監護人必須詳讀保證書之內容以徹底瞭解相關之責任義務。3、 （A）項請申請者親筆簽名。 （B）項必須請申請者親生父母雙方或法定監護人簽名即使父母離婚，沒有監護權之一方也必需

10、簽名同意，除非申請者有其他之法定監護人。 （C）項請派遣社社長簽名。 4、其他（C）、（D）、（E）、（F）由接待地區完成簽字n 第1112計劃規則與交換條款（Program Rules Conditions of Change）1、 申請者與親生父母，必須詳讀並遵守相關規範與條款，以避免因觸法 而在交換期間被提早遣回2、所有簽名必須是原筆跡且在扶輪社代表的見証下完成3、接待地區可依其須要增減或修改本申請書所述之規章條款並適時告知申請者n 第13頁：學校機要報告（Confidential School Report）將此頁個人資料填妥並簽名後，請學校之校長、教務長、顧問或老師，對申請者有充份瞭

11、解者完成此報告，連同英文申請書送交地區。長期交換 Supplemental Information 中英對照此份資料為接待地區、接待社、接待家庭對你的第一印象及評價，也是決定是否接侍你的關鍵報告，請務必好好填寫！1、 What are your school interests and activities？ What offices or leadership positions have you held？你在學校對什麼感興趣？較投入什麼活動？你曾經擔任什麼領導職位？提出什麼服務？2、 What are your hobbies and accomplishments？（e.g., art

12、, music, sports, etc.）Elaborate on your interests in these areas.（e.g., Why did you become interested in the activity？How long have you been interested？How much time do you devote to activity？）你有什麼嗜好和才藝？（例如藝術、音樂、運動等）盡量敘述你興趣的範圍。（例如為什麼對這項活動有興趣？喜歡它多久了？花多少時間用在你的興趣上？）3、 What are you future plans and ambi

13、tions concerning your education and future career？Why？對於你的教育和將來職業規劃，你未來的計劃和目是什麼？為什麼？4、 What do you specifically hope to accomplish as an Exchange Student, both during your year and when you retum？以一個交換學生的身份，在擔任的期間和任期之後，你特別想完成的是什麼？5、 Elaborate on the occupations of your mother and father.（e.g., What

14、product or service does each make or perform？ What is her/his position or title？）敘述你父母的職業。（例如：生產製造何種產品？或服務於哪裡？職務及職務抬頭是什麼？）6、 Tell us about trips that you have taken outside your country. Why did you take these trips, with whom, for how long, etc.？你曾經離開自己國家外出旅行嗎？為什麼出外旅行？和誰一起出去？多久？7、 We all dislike ce

15、rtain things. List those things which you dislike.（e.g., what kind of foods, certain animals, certain treatment by other people, etc.）我們都很討厭某些特定事物。列出你最不喜歡的事物。（例如：不喜歡的食物、動物、什麼人的行為舉止你不喜歡。）8、List what you feel are your strong characteristics. 列出你覺得什麼是你自己強烈獨特的個性。9、List what you feel are your weak charac

16、teristics. 列出你覺得什麼是你自己軟弱的個性。10、Describe a typical non-school day in your life.（e.g., What do you do when you have free time？） 敘述一天不用上課的日子。（例如當你不上課或放假時。你會在做什麼？）11、Describe what you do at your school.（e.g., How many subjects do you take？ What are they？ How long are the classes？ What is your daily sche

17、dule during your school year？ Start with your wake-up time and discuss only one typical days schedule.）If you have course choices at your school. Tell what and why you chose as you did. 敘述你在學校的情形。 （例如：你要上多少科目？這些科目是什麼？上課時間有多長？你的每日上課時間表是什麼？從你起床後開始，舉例你一天的生活行程。）如果你的學校採取自由選課方式，告訴我你選了哪些課？為什麼選這些課？12、Descri

18、be your home.（e.g., Do you have your own room？ Do you share your room with others？ Where in your house do you study？ How far is your home from your school？ Do you drive, ride the bus, or walk to school？） 敘述你的家。 （例如：你有自己的房間嗎？還是和誰分享一個房間？你在家裡什麼地方閱讀？從家裡到學校有多遠？你如何到學校？開車，坐公車還是走路？）13、How many brothers and

19、sisters do you have, what are their ages and what do they do？（e.g., Do they live at home？ Are they in school, university？ What are they studying（degree goal）？If working. What is their job？） 你有幾個兄弟姊妹？他們幾歲？都在做什麼？ （例如：他們住家裡嗎？唸什麼學校？中小學或大學？如有人在工作，做什麼工作？）14、Describe your community.（e.g., location relative

20、 to major city, population, industry, economy, etc.） 敘述你住的地方或社區。（例如位於哪裡？與城市距離、人口、工業、經濟）15、What is your favorite book and author？ Why？ About how many books do you read each month？ 什麼是你最喜歡的書及作家？為什麼？你每個月唸幾本課外書？16、Identify four major issues confronting youth today. Select the most major issue and tell u

21、s why it is of personal concem. 列出你認為4件主要讓現代年輕人感到衝擊及震撼的事件。選擇最主要事件告訴我們你個人的感想。Application for a Rotary Youth ExchangeLong Term ProgramA Study Year AbroadSubmit completed application to:Read instructions on pages i-iii before completing applicationInstructions for Rotary Youth Exchange Program Applicat

22、ionRead these directions carefully before completing the application.If you are accepted as an exchange student, this application will be sent to your host country. It will serve as your introduction to the people who are being asked to host you. It is important that the first impression you make be

23、 a good impression.Complete this application carefully. All grammar and spelling should be correct. And remember, neatness counts.GENERAL INSTRUCTIONS:Applications must be legible. Typed or computer generated applications are preferred. Answer all questions as asked. Donot write “same” or “see page,

24、” etc. Type answers on the application except where otherwise indicated. Practice on a draftcopy of the application to make sure your answers fit in the space provided.Signatures:All signatures must be originals and written in BLUE ink on all four copies. To accomplish this, complete one full applic

25、ationbut do not sign it. Make three copies and then sign all four completed applications. Student signature is required five timesand parents or guardians signatures are required three times on each copy of the application. To help you find signaturelocations, all signature locations have been place

26、d in boxes and asterisked (*). Request the doctor and dentist to make copiesbefore they sign.Photographs:Original pictures or color photocopies must accompany all four copies of the application. You will need four head-and-Shoulder pictures of yourself and four copies of each photograph requested on

27、 the Picture Page 8. You may use a color copier.Pictures should be attached using a gluestick or double-sided tape. Do not staple the pictures.Dates:Use the alphabetic abbreviation for month, e.g., (1986/Feb/22); not the numeric. Please note that this annotation of dates is theInternational Standard

28、 and may be different from what you are used to.Telephone Numbers:Please include all country, city and area codes for telephone numbers.Abbreviations:YE Youth ExchangeYEO Youth Exchange OfficerOther:If you have any questions concerning the completion of this application, check with your school couns

29、elor or your local RotaryClubs Youth Exchange Officer. Upon completion of your application, return it to your local Rotary Club or school official inaccordance with their instructions.SPECIFIC INSTRUCTIONS:Page 1:Applicant and Parents/Legal Guardian All parental information must be completed. If you

30、r parents are divorced, providethe requested information for the non-custodial parent, not your step-parent unless he/she has legal guardianship of you orhas formally adopted you. If someone other than a parent is your legal guardian, provide the requested information for thelegal guardian. Authoriz

31、ations must be obtained from all parents/guardians. Emergency telephone numbers must bedifferent than the home and business phone numbers. This should be a telephone number by which we can contact yourparents in an emergency. If your parents have a fax number ore-mail address, type it in the space p

32、rovided.Date of Birth Remember to use use the alphabetic abbreviation for month, e.g., (1986/Feb/22); not the numeric. Please notethat this annotation of date of birth is the International Standard and may be different from what you are used to.Rotary Youth Exchange Program Application iRotary Club

33、and District Endorsement This will be completed by your Rotary Club and District Youth Exchange Commit-tee. Give all four copies to your Rotary contact for signature. In some cases, the school arranges for this. Check with yourguidance counselor. The District Endorsement will be completed if and whe

34、n you are selected.Page 2: Secondary School and Personal InformationThe number of years attended school should not include kindergarten or the equivalent.Obtain an official transcript or record from your school of all courses completed in the last two years and include it with yourapplication. A rec

35、ord of the school courses you have completed and the grades received is important in order for your HostSchool to place you in appropriate classes during your exchange year. It should be translated into English.If you have studied a foreign language, please give us your personal assessment of your p

36、roficiency.If you smoke, drink alcoholic beverages or have a past or current involvement with illegal drugs, be sure to provide theexplanatory information requested. A “Yes” answer will not automatically eliminate you as a candidate, however, it willnecessitate special consideration of host family a

37、ssignments. If necessary, add an additional page. In your explanation addressthe following question: “How would living with a family where smoking or drinking is prohibited affect my exchange year?”The “Secondary School Principal/Guidance Counselor Report” may be completed by the principal, headmast

38、er, guidancecounselor, dean of students or other school official who is in a position of administrative authority and is familiar with you. Itshould not be completed by a teacher. This page should be returned to you and submitted with your application.Pages 3-5: Medical and Dental ExaminationsMake y

39、our doctor appointments now. This portion of the application must be completed by the time you come to the Districtinterviews. This part of the application must be completed by a licensed medical doctor and dentist who is not an immediatefamily member.No student will be considered at the District le

40、vel without a completed medical and dental examination. If you do not reachthe District level interview, you may cancel the appointments. All information must be completed on the application asrequested. Some doctors furnish letters stating that patients have had regular checkups and are in good hea

41、lth. This is notacceptable. Should you need medical care while overseas, the host country doctor needs some medical information about you.Be sure you have a TB Mantoux test as required. Encourage your doctor to write legibly.Page 5: Permission for Medical Care and Release of Medical Records and Liab

42、ilityRead carefully. If you are ill and require medical care, this gives permission for your host family and/or a hosting Rotarian toact for your parents or guardians. This holds your natural parents and/or guardians responsible for additional medical billsand transportation costs not covered by you

43、r insurance if required by your illness. You and both parents or guardians mustsign where indicated. If your parents are divorced, you must get the signature of the non-custodial parent unless someone elsehas legal guardianship of you. Authorizations must be obtained from all parents and guardians.E

44、mergency Contact: Provide the name and telephone/fax of a family member or close friend of your parents who may becontacted in case of an emergency if we cannot contact your parents. This should be someone who your parents trust to makedecisions about your medical care when your parents are not avai

45、lable.Page 7: Supplemental InformationThe sponsoring Rotary club and district must complete the top section of page 7.If you have any dietary restrictions, be sure to state clearly what you cannot and/or will not eat. Also please tell us if theserestrictions are based on medical advice, based on you

46、r religion, or you own personal preferences.Rotary Youth Exchange Program Application iiAnswer each question in detail but keep to three pages (single spaced on A4 or 8 in. x 11 in. paper). Your answers to thequestions should be typed and show some thought. Again, spelling, grammar and neatness coun

47、t. Give thought to yourphotographs and the message you are communicating to your future host Rotary club and host families.Page 8: Picture PageOnce you have your four pictures, show them to the Rotarian or teacher assisting you. If the pictures are approved for thepurpose here, affix the pictures to

48、 the page with glue or double-sided tape (do not staple). You may either make color copies ofthe page or use all original copies of the pictures. Poor, unclear or cluttered pictures tell others that you did not take the time toprepare a good application.In the “my family” section include immediate f

49、amily members in the picture if possible. In the “special interest” sectioninclude a photograph of you doing your favorite hobby or activity. In the “something important to me” section include aphotograph of your pet(s), friends, etc. Describe the subject below the photograph if not obvious.Page 9:

50、Guarantee FormThis is part of the visa application, so complete it carefully. Be sure to include your country in your home address.(A) Applicants Guarantee: Read carefully so you clearly understand all items.(B) Parents/Guardians Guarantee: Read carefully so you clearly understand your responsibilit

51、ies and obligations. Bothparents or legal guardians must sign. If parents are divorced, the non-custodial parent must sign unless someone else has legalguardianship. Witness signature may be left blank if club official is not present. A District-level Rotarian can sign here.Part C, D, E and F will b

52、e completed in your host country. Receiving clubs should fill in the amount of the monthly allowancein US equivalent dollars.Page 11-12: Program Rules and Conditions of ExchangeParents and students should read these carefully. You are expected to abide by these rules and conditions of exchange while

53、 aparticipant in the Rotary Youth Exchange program. Failure to do so may result in the termination of your exchange year andearly return home. All signatures must be originals. This should be signed in the presence of a Rotary Club representative.Note: These are rules and conditions jointly agreed to by most Rotary Districts. However, your Hosting District may add,modify or delete some of these rules and/or conditions. You will be informed by your Hosting District of any changes.Page 13: Confidential School ReportPlease print or type your name and address and sign on the t