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For more info on the Formosa Foundation Ambassador Program, please visit:http://taiwanchinasummerprograms.blogspot.com/2011/01/ambassador-program.html
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Application Form Page 1 of 4
Application Form (For U.S. Applicants)
A. PERSONAL INFORMATIONFirst Name Taiwanese name (if applicable)
Date of Birth (mm/dd/yyyy) Place of Birth - City, State Citizenship US Citizen US Permanent Resident
Country of Citizenship if not UScitizenEmail Address
@Gender
Male FemaleSocial Security Number
Permanent Address
Street City State Zip Code+4 CountryTelephone Number (Day) Telephone Number (Night)
Name of Parents (English & Taiwanese if applicable)
Father MotherEmergencyContact
Phone Relationship
B. EDUCATIONAL INFORMATION List Chronologically the five most recent educational institutions attended since high school.High School City State Year Graduated GPA (e.g. 3.0/4.0)
Name of School City State From (mm/yy)
to
GPA (e.g. 3.0/4.0)
College, University, Graduate and/or Professional School:
Name of School City State From (mm/yy)
to
GPA (e.g. 3.0/4.0)
Name of School City State From (mm/yy)
to
GPA (e.g. 3.0/4.0)
Best SAT/ACT Score:
Degree Received/Expected and Major(s)
Degree Received/Expected and Major(s)
/
/
/
/
M.I.
Mailing Address Good Through (mm/yyyy):
Street City State Zip Code +4 Country
Last Name
Graduate entrance exam, if applicable. Score:
Degree Received/Expected and Major(s)
Year Taken:
Type:
List significant scholastic honors, including scholarships, prizes honor societies, etc.
In an academic setting, have you been subject to disciplinary sanctions, or are charges pending? No Yes
Have you ever been expelled, suspended, placed on probation, or given an academic warning? No Yes
Have you ever been convicted of a felony? No YesExplanation for any "Yes" answers to the above:
C. LEADERSHIP AND EXTRACURRICULAR ACTIVITIES (check all applicable)
Business InternshipCommunity Volunteer
Issue Advocacy & AwarenessPolitical/ Government InternshipModel U.N./ Mock Congress Debate
List and describe relevant activities you have participated in the above. Include achievements, positions held, periods of involvement, and average hours per week ofparticipation. (Use separate sheet if necessary) List Taiwanese American activities in Section E.
Application Form Page 2 of 4
Other, please specify:
Non-Profit WorkJournalism/ Media
Student Body Leadership
D. TAIWANESE AMERICAN COMMUNITY ACTIVITIES (Fill in when applicablel. Please include dates and involvement)
Position/Responsibility
Hrs/Week Reason for leaving
Employer 2
Position/Responsibility
Hrs/WeekFrom mm/yy to mm/yy Reason for leaving
Employer 3
Position/Responsibility
City, State
From mm/yy to mm/yy Reason for leaving
Employer 4
Position/Responsibility
City, State
Hrs/WeekFrom mm/yy to mm/yy Reason for leaving
Employer 1
City, State
Application Form Page 3 of 4
Hrs/Week
F. EMPLOYMENT INFORMATIONWhere applicable, list the three most recent employments, including summer and/or part-time employment, internship and military services:
1. In your opinion, what is the greatest challenge facing Taiwan today?
2. As part of the solution to the above, what can you do to help?
E. WRITE-IN ANSWERS Please limit your answers to 150 words or less for each question.
City, State
From mm/yy to mm/yy
Application Form Page 4 of 4
H. CERTIFICATION:
I, the undersigned, hereby certify that all the information provided in this application is accurateand complete. I will promptly inform the Foundation in writing of any changes in any of the factsstated therein. I understand that providing any false, misleading, or incomplete information willresult in the rejection of my application or the revocation of my admission to the Program. Ifselected, I agree to abide by all Program rules.
Signature of Applicant Name of Applicant Date
Application package must include the following:1. Completed Application Form;2. A 500-word Personal Statement;3. Copy of most recent transcript4. Two (2) letters of recommendation;5. Any optional supplementary material to help the selection committee evaluate this application.
Submit 1 original set plus 4 duplicate sets of the above items to:
Formosa Foundation350 South Figueroa Street, Suite 275
Los Angeles, CA 90071
All material must be received on or before March 15, 2011. If sending via express mail (e.g., FedEx orUPS Next Day), designate "afternoon" delivery and waive signature requirement. To contact the FormosaFoundation, please call (213) 625-1991, or fax (213) 625-1941; Email: [email protected].
Position/Title Organization Phone number
Name Position/Title Organization Phone number
Name
Relationship to Applicant Email Address
Relationship to Applicant Email Address
G. TWO (2) REFERENCES List those who are not already writing letters of recommendation.
I. APPLICATION INSTRUCTIONS: