5 de enero al 17 de marzo de 2016

Embajada de la República de China (Taiwán) en Panamá
Ave. Samuel Lewis, Torre Banistmo (al lado del Santuario Nacional), Piso 10, Ciudad de Panamá
Tel: 264-0851/223-3424 Fax: 269-8757 Website: www.taiwanembassy.org/pa
International Higher Education Scholarship Programs 2016
Patrocinador: Embajada de la República de China (Taiwán) en Panamá
Objetivos:
El Fondo para la Cooperación y el Desarrollo Internacional
(TaiwanICDF) de la República de China (Taiwán), ofrece a los
estudiantes y profesionales panameños un programa para cursar
estudios de licenciatura, maestría y doctorado en Taiwán, con el
propósito de capacitar y especializar el recurso humano para el
mayor progreso social y económico, fortaleciendo de esta
manera los lazos de amistad, la cooperación y el intercambio
cultural entre la República de China (Taiwán) y la República de
Panamá.
Inicio y Cierre del Concurso: 5 de enero al 17 de marzo de 2016
Anuncio del resultado: 1 de julio de 2016
Duración: La Beca “International Higher Education Scholarship Programs
2016” ofrece 30 carreras en idioma inglés:
Licenciatura: Cuatro (4) años
Maestría:
Dos (2) años
Doctorado:
Cuatro (4) años
1
Embajada de la República de China (Taiwán) en Panamá
Ave. Samuel Lewis, Torre Banistmo (al lado del Santuario Nacional), Piso 10, Ciudad de Panamá
Tel: 264-0851/223-3424 Fax: 269-8757 Website: www.taiwanembassy.org/pa
BENEFICIOS DE LA BECA:
 30 carreras universitarias a elegir (ver anexo 1°).
 El TaiwanICDF proporcionará a los becarios un subsidio mensual de
NT$12,000 (equivalente a US$364.00, aproximadamente) para
licenciatura; NT$15,000 (equivalente a US$455.00, aproximadamente)
para maestría y NT$17,000 (equivalente a US$515.00,
aproximadamente) para doctorado, con el fin de cubrir los gastos
personales de los becarios, mientras que el boleto aéreo en clase
económica de ida y vuelta Panamá-Taiwán, alojamiento (dormitorio en
la universidad), seguro médico y de accidentes, matrícula, libros de
texto, serán cubiertos por el TaiwánICDF.
Documentos Requeridos:
1
2
3
4
5
6
7
Formulario impreso de aplicación debidamente completado con su firma
(visite la página web http://www.icdf.org.tw/TSP/WelcomeStart.aspx)
Certificado de buena salud de los últimos 3 meses (ver anexo 2°)
Copia del pasaporte o de la cédula de identidad de Panamá
Copia del diploma y créditos
Tener un alto nivel del idioma inglés (Presentar el resultado del TOEFL
o IELTS, o el diploma en el cual conste que haya estudiado una carrera
en inglés)
Dos (2) cartas de recomendación
Paz y Salvo (se solicita en el IFARHU)
2
Embajada de la República de China (Taiwán) en Panamá
Ave. Samuel Lewis, Torre Banistmo (al lado del Santuario Nacional), Piso 10, Ciudad de Panamá
Tel: 264-0851/223-3424 Fax: 269-8757 Website: www.taiwanembassy.org/pa
Procedimiento de la solicitud:
1. Presentar todos los documentos antes mencionados a la Embajada de la
República de China (Taiwán) en Panamá. Los aplicantes sólo pueden
elegir una (1) carrera. Una vez se entregan los documentos no
se devuelven los mismos.
2. Enviar otros documentos a las universidades, de acuerdo a lo solicitado,
antes de la fecha límite indicada por las mismas (ver anexo 3°).
3. La carta de admisión de las universidades no garantiza la
obtención de la beca. Los ganadores de la beca serán
formalmente informados por la Embajada y a través de una
“Letter of Acceptance” (Carta de Aceptación) emitida por
el TaiwanICDF.
Siguientes pasos sólo para los seleccionados finales
1. Solicitar visas, y participar en las reuniones informativas: julio de 2016
2. Fecha aproximada de salida de Panamá: finales de agosto de 2016
3. Inicio de clases: septiembre, 2016.
3
”Beca Diplomática de la República de China (Taiwán) ” 2016
Patrocinador:
Embajada de la República de China (Taiwán) en Panamá
Colaborador:
Instituto para la Formación y Aprovechamiento de los
Recursos Humanos (IFARHU) de la República de Panamá
Inicio y Cierre del Concurso: 11 de enero al 17 de marzo de 2016
Entrevista: 31 de marzo y 1 de abril de 2016
(se anunciará una semana antes a través de la página web de la
Embajada a los participantes que irán a la entrevista)
Anuncio del resultado: 1 de julio de 2016
Duración: La “Beca Diplomática de la República de China (Taiwán) ” ofrece
estudios para las siguientes carreras:
Licenciatura: Un (1) año de aprendizaje del idioma chino-mandarín y
los siguientes cuatro (4) años para estudio de la carrera
Maestría:
Un (1) año de aprendizaje del idioma chino-mandarín y
los siguientes dos (2) años para estudio de la carrera
Doctorado:
Un (1) año de aprendizaje del idioma chino-mandarín y
los siguientes cuatro (4) años para estudio de la carrera
BENEFICIOS DE LA BECA:
 Carreras universitarias a elegir: Todas las carreras con excepción de
medicina y turismo.
4
 El Gobierno de la República de China (Taiwán) ofrece el boleto aéreo
Panamá-Taipei-Panamá, en clase económica, un subsidio mensual de
25,000.00 Dólares Taiwaneses
(equivalente a US$758.00,
aproximadamente) para el primer año de estudio del mandarín, y un
subsidio mensual de 30,000.00 Dólares Taiwaneses (equivalente a
US$910.00, aproximadamente) para los siguientes años. Con este apoyo
económico los becarios cubrirán sus gastos tales como: matrícula,
libros de texto, hospedaje, transporte, alimentación, seguro médico, etc.
LIMITACIÓN: Los aplicantes no pueden haber sido beneficiados con
ninguna beca ofrecida por el Gobierno de la República de
China (Taiwán)
Documentos Requeridos: (Una vez se entreguen los documentos, no
se devolverán los mismos)
Formulario de aplicación “Beca Diplomática de la República de China
(Taiwán)” (anexo 1°)
2 Certificado de buena salud de los últimos 3 meses (anexo 2°).
3 Fotografías tipo carnet, fondo blanco, tomadas en los últimos 6 meses y
pegadas en los formularios de aplicación y certificado de buena salud
4 Copia del pasaporte o de la cédula de identidad de Panamá
5 Copia del Diploma de Bachillerato autenticada por el IFARHU
6 Copia de los Créditos Escolares autenticada por el IFARHU (Puntaje
Mínimo 4 para Licenciatura, Puntaje Mínimo 2 para Maestría y
Doctorado).
7 Dos cartas de recomendación
8 Paz y Salvo (se solicita en el IFARHU)
9 Un ensayo sobre sus motivos de estudiar en Taiwán. (una página de
tamaño carta solamente)
10 Certificado del examen TOCFL (Huayu-Top) (opcional)
1
5
Siguientes pasos sólo para los seleccionados finales
1. Solicitar Carta de Admisión de un centro de idioma chino-mandarín de
Taiwán para los cursos que empiezan el septiembre de 2016. (anexo 3°)
2. Autenticar los documentos y solicitar las visas
3. Reuniones informativas en la Embajada: 15 de julio
4. Fecha aproximada de salida de Panamá: finales de agosto
5. Inicio de clases: septiembre
Listado de los Centros del idioma chino-mandarín de Taiwán (anexo 3°)
Listados de las Universidades de Taiwán (anexo 4°)
6
附件一
外交部臺灣獎學金申請表(範例)
APPLICATION FORM FOR THE MOFA TAIWAN SCHOLARSHIP
Applicants should fill out this application form clearly and accurately. Detailed answers are required in
order to make the most appropriate arrangements. If necessary, additional pages of the same size may
be attached. 本表請申請人詳實工整填寫，慎勿遺漏，以利配合作業，如有需要，申請人可自行以同款紙張加
頁說明.
Please check: 請選以下選項
Which type of scholarship are you applying for?
□Undergraduate Scholarship 大學獎學金
□Master Scholarship 碩士獎學金
□Doctoral Scholarship 博士獎學金
Do you need to attend a Mandarin Language Enrichment Program (this must be undertaken during the
first year) (是否先修華語？華語課程必須在抵臺第一年研修)? □ Yes □ No If Yes, please fill in the name of the
language center in part 6 on page 4
1. Personal information 個人基本資料
a. Name 姓名
Title 稱謂: Mr./Mrs./Ms.
Please attach a recent
photograph (taken within
the last 3 months).
Surname (Last name)姓:
Given Name(s) 名:
最近三個月相片
b. City and country of birth
出生.城市及國別
c. Nationality 國籍
d. Parents
家長資料
*Note: If one or both of your parents was an ROC national at the time of
your birth, you are also an ROC national and therefore not eligible to
apply.
Father 父
Mother 母
Name 姓名:
Name 姓名:
Nationality 國籍:
Nationality 國籍:
Place of birth 出生地:
Place of birth 出生地:
7
e. Contact information
Permanent address 永久地址:
聯絡地址、電話、電子
郵件
Mailing address (if different from above)郵寄地址:
Telephone 電話:
Email 電子郵件:
Cell phone 手機:
f. Sex 性別
□ Male 男
g. Marital status
婚姻狀況
□ Single 單身
h. Date of birth
生日
(Day 日／Month 月／Year 年):
i. Have you ever resided
in Taiwan?
□ Female 女
□ Married 已婚
□Never 否; □Yes, from
(dd/mm/yr) to
Reason for residence 居住事由:
居住臺灣
j. Have you received a □No 無; □Yes, from
(dd/mm/yr) to
Taiwan Scholarship or
Huayu
Enrichment Type(s) of Scholarship:
Scholarship before?臺
灣獎學金/華語文獎學
金受獎紀錄
k. Health condition
健康狀況
□ Excellent
l. Chronic diseases 慢性病
□ None 無
(dd/mm/yr).是，起迄日期
(dd/mm/yr);是，起迄日期
□ Good □ Fair
□ Yes 有 Please specify 請指明:
m. Contact person in case
of emergency
緊急事件聯絡人
Name 姓名:
Relationship 關係:
Address 地址:
Telephone 電話:
Email 電子郵件:
Cell phone 手機:
8
2. Language proficiency 語言能力
Language
proficiency
語言能力
Comprehension
聽
Excellent
優
Good
良
Fair
可
Reading
讀
Excellent
優
Good
良
Writing
寫
Fair
可
Excellent
優
Good
良
Speaking
說
Fair
可
Excellent
優
Good
良
Fair
可
Chinese
English
(Other, please
state)
3. Education and training 教育背景
School name
學校名稱
Subject
研修領域
Note: Highest diploma only
Qualification
(Certificate/Diploma/
Degree)
資格
Country and place
地點
Year obtained
取得證書時間
4. References 推薦單位 (人) 資料
Name 姓名
Position 職務
Telephone, email or mailing address 電話及電郵地址
5. Employment/Job experience (use one row for each position) 工作經歷
Position
職務
Company/Organization
機構名稱
Period of employment
服務期間
9
Responsibilities
工作說明
6. Language center and/or university/department which you plan to attend in Taiwan 擬就讀之語文中心
或∕及大學校院系所
University affiliated language center:
University/college and department:
10
7. RECOMMENDATIONS OF LOCAL AUTHORITY OR ORGANIZATION (e.g. Government
Agency, Educational Institute, Think Tank, International Organization, Non-governmental
Organization) 駐地推薦單位，如駐在國政府機關、教育或研究機構、智庫或非政府組織
Comments on applicant:
Responsible official: Title_______________________ Signature:__________________
Name:_____________________ Date:_____________________
11
8. Please briefly state your study plan while in Taiwan 請簡述在臺讀書計畫
12
9. DECLARATION: I hereby declare that:
□The information I have provided in this document is true and accurate. I understand that any
false information will disqualify me from the program, even if it is already in progress.
□I am not suffering from any serious disease and am not hindered by any illness or disability.
□I am neither an ROC national, nor an overseas compatriot of the ROC.
□I am not currently undertaking studies in Taiwan at the same educational level as the
scholarship type for which I am applying.
□I am not applying for this scholarship as an exchange student through an agreement signed
between an educational institution in Taiwan and an educational institution outside of Taiwan.
□I consent to the information provided in this application form being made available to ROC
government agencies for scholarship-related matters once I become a Taiwan Scholarship
recipient.
Applicant’s signature
Date
_____ ／_____ ／_____
Day 日／Month 月／Year 年
13
Listing of Chinese Language Centers
National Taipei University Chinese Language Education
of Education
Tel: +886-2-27321104
ext.2025, 3331
Center
Room 700C, No.134, Sec. 2,
Fax: +886-2-27325950
Heping E. Rd., Da-an District,
Taipei City 106, Taiwan(R.O.C.)
Mail: [email protected]
National Taiwan Normal
University
National Sun Yat-Sen
University
Mandarin Training Center
No.162 Hoping East Road ,
Sec.1 Taipei,Taiwan 106
Chinese Language Center
No. 70 , Lian-hai
Rd. , Kaohsiung , 80424Taiwan
Tel: +886-2-77345130
Fax: +886-2-23418431
Mail: [email protected]
Tel: +886-7-5252000 ext.
3030~3031
Fax: +886-7-5253039
Mail: [email protected]
National Taipei University Chinese Language Training
of Technology
Center
1, Sec. 3, Zhongxiao E. Rd.,
Taipei 10608 Taiwan, R.O.C.
14
Tel:+886-2-2771-2171 ext 1742
、1704、1703、1746
Fax：+886-2-2752-4269
Mail: [email protected]
List of Universities & Colleges
SY 2015-2016
Code
School Name
Address
Telephone
Website
0001
National Chengchi University
NO.64,Sec.2,ZhiNan Rd.,Wenshan District,Taipei City
11605,Taiwan, R.O.C.
(02)29393091
http://www.nccu.edu.tw
0002
National Tsing Hua University
No.101, Section 2, Kuang-Fu Road, Hsinchu, Taiwan
30013, R.O.C.
(03)5715131
http://www.nthu.edu.tw
0003
National Taiwan University
No. 1, Sec. 4, Roosevelt Road, Taipei, 10617 Taiwan
R.O.C.
162,HePing East Road Section 1, Taipei, Taiwan
No.1, University Road, Tainan City 701, Taiwan, R.O.C.
145 Xingda Rd., South Dist., Taichung City 402,
Taiwan, R.O.C.
1001 University Road, Hsinchu, Taiwan 300, ROC
No.300, Jhongda Rd., Jhongli District, Taoyuan City
32001, Taiwan R.O.C.
(02)33663366
http://www.ntu.edu.tw
(02)77341111
http://www.ntnu.edu.tw
(06)2757575
http://www.ncku.edu.tw
(04)22873181
http://www.nchu.edu.tw
(03)5712121
http://www.nctu.edu.tw
(03)4227151
http://www.ncu.edu.tw
0004
National Taiwan Normal University
0005 National Cheng Kung University
0006 National Chung Hsing University
0007
0008
0009
National Chiao Tung University
National Central University
National Sun Yat-sen University
National Taiwan Ocean University
No. 70, Lienhai Rd., Kaohsiung 80424, Taiwan, R.O.C.
No.2, Beining Rd., Jhongjheng District, Keelung City
202, Taiwan (R.O.C)
(07)5252000
http://www.nsysu.edu.tw
0012
(02)24622192
http://www.ntou.edu.tw
0013
National Chung Cheng University
No.168, Sec. 1, University Rd., Min-Hsiung Township,
Chia-yi County 621, Taiwan R.O.C.
(05)2720411
http://www.ccu.edu.tw
0014
National Kaohsiung Normal University
No.116, Heping 1st Rd., Lingya District, Kaohsiung City (07)7172930
802, Taiwan, R.O.C.
http://www.nknu.edu.tw
No.1, Jin-De Road, Changhua 500, Taiwan, R.O.C.
(04)7232105
http://www.ncue.edu.tw
No.155, Sec.2, Linong Street, Taipei, 112 Taiwan,
R.O.C.
151, University Rd., San Shia District, New Taipei City,
23741 Taiwan, R.O.C.
(02)28267000
http://www.ym.edu.tw
(02)86741111
http://www.ntpu.edu.tw/chinese/
0015
National Changhua University of
Education
0016 National Yang-Ming University
0017
National Taipei University
0018
National Chiayi University
National University of Kaohsiung
No.300 Syuefu Rd., Chiayi City 60004, Taiwan, R.O.C.
700, Kaohsiung University Rd., Nanzih District, 81148.
Kaohsiung, Taiwan, R.O.C.
(05)2717000
http://www.ncyu.edu.tw
0019
(07)5919000
http://www.nuk.edu.tw
0020
National Dong Hwa University
No. 1, Sec. 2, Da Hsueh Rd. Shoufeng, Hualien 97401,
Taiwan, R.O.C.
(03)8635000
http://www.ndhu.edu.tw
0021
National Chi Nan University
No.1, University Rd, Puli, Nantou County,54561
Taiwan, R.O.C.
(049)2910960#2996 http://www.ncnu.edu.tw
15
0022
National Taiwan University of Science
and Technology
No.43, Sec. 4, Keelung Rd., Da’an Dist., Taipei 106,
Taiwan R.O.C.
(02)27333141
http://www.ntust.edu.tw
0023
National Yunlin University of Science
and Technology
123 University Road, Section 3, Douliou, Yunlin 64002,
Taiwan, R.O.C.
(05)5342601
http://www.yuntech.edu.tw
0024
National Pingtung University of Science
and Technology
1, Shuefu Road, Neipu, Pingtung 912, Taiwan, R.O.C.
(08)7703202
http://www.npust.edu.tw
0025
National Taipei University of Technology
(02)27712171
http://www.ntut.edu.tw
0026
National Kaohsiung First University of
Science and Technology
1, Sec. 3, Zhongxiao E. Rd., Taipei 10608 Taiwan,
R.O.C.
No.1, University Rd., Yanchao Dist., Kaohsiung City,
824, Taiwan, R.O.C.
(07)6011000
http://www.nkfust.edu.tw
0027
National Kaohsiung University of
Applied Sciences
No.415, Jiangong Rd., Sanmin Dist., Kaohsiung City
807, Taiwan R.O.C.
(07)3814526
http://www.kuas.edu.tw
0028
Taipei National University of the Arts
(02)28961000
http://www.tnua.edu.tw
0029
National Taiwan University of Arts
1 Hsueh-Yuan Rd., Peitou District, Taipei 11201,
Taiwan, R.O.C
59,Sec. 1, Daguan Rd., Banqiao Dist., New Taipei City
22058, Taiwan, R.O.C.
(02)22722181
http://www.ntua.edu.tw
0030
National Taitung University
National Ilan University
369, Sec. 2, Shikang Rd., Taitung, Taiwan, R.O.C
No.1, Sec. 1, Shennong Rd., Yilan City, Yilan County
26047,Taiwan, R.O.C.
(089)318855
http://www.nttu.edu.tw
(03)9357400
http://www.niu.edu.tw
National United University
National Formosa University
1, Lienda, Miaoli 36003, Taiwan, R.O.C.
No.64, Wunhua Rd., Huwei Township, Yunlin County
632, Taiwan, R.O.C.
(037)381000
http://www.nuu.edu.tw
0033
(05)6315000
http://www.nfu.edu.tw/main.php
0034
National Kaohsiung Marine University
No.142, Haijhuan Rd., Nanzih Dist., Kaohsiung City
81157, Taiwan R.O.C.
(07)3617141
http://www.nkmu.edu.tw
0035
Tainan National University of the Arts
No.66,Daci Village,Guantian District,Tainan City,72045
Taiwan, R.O.C.
(06)6930100
http://www.tnnua.edu.tw
0036
National University of Tainan
National Taipei University of Education
33, Sec. 2, Shu-Lin St.,Tainan 700, Taiwan, R.O.C.
No.134, Sec. 2, Heping E. Rd., Da-an District, Taipei
City 106, Taiwan, R.O.C.
(06)2133111
http://web.nutn.edu.tw/
(02)27321104
http://www.ntue.edu.tw/
National Hsinchu University of Education No.521, Nan-Da Rd., Hsinchu City 30014 ,Taiwan,
R.O.C.
0039 National Taichung University of
No.140, Minsheng Rd., West Dist., Taichung City
Education
40306, Taiwan R.O.C.
(03)5213132
http://www.nhcue.edu.tw/
(04)22183199
http://www.ntcu.edu.tw
0042
National Penghu University of Science
and Technology
No.300, Liuhe Rd., Magong city, Penghu County 880,
Taiwan,R.O.C.
(06)9264115
http://www.npu.edu.tw
0043
National Chin-Yi University of
Technology
No.57, Sec. 2, Zhongshan Rd., Taiping Dist., Taichung
41170, Taiwan R.O.C.
(04)23924505
http://www.ncut.edu.tw
0044
National Taiwan Sport University
No.250, Wenhua 1st Rd., Guishan, Taoyuan 33301,
Taiwan R.O.C.
(03)3283201
http://www.ntsu.edu.tw
0046
National Taipei University of Nursing and No.365,Ming-te Road,Peitou District,Taipei
Health Science
City,Taiwan, R.O.C.
(02)28227101
http://www.ntunhs.edu.tw/bin/home.php
0031
0032
0037
0038
16
0047
National Kaohsiung University of
Hospitality and Tourism
81271 No.1, Songhe Rd., Xiaogang Dist., Kaohsiung
City, Taiwan (R.O.C.)
(07)8060505
http://www.nkuht.edu.tw
0048
National Quemoy University
No. 1, University Rd., Jinning Township, Kinmen
County 892, Taiwan R.O.C
(082)313300
http://www.nqu.edu.tw/cht/index.php
0049
National Taiwan University of Physical
Education and Sport
NO. 16, SECTION 1, SHUANG-SHIH ROAD
TAICHUNG, TAIWAN, 404 R. O. C.
(04)22213108
http://www.ntupes.edu.tw
0050
National Taichung University of Science
and Technology
No.129,Sec.3,Sanmin Rd,North Dist.,Taichung City 404, (04)22195678
Taiwan R.O.C.
http://www.nutc.edu.tw/bin/home.php
0051
National Taipei University of Business
No.321, Sec. 1, Jinan Rd., Zhongzheng District, Taipei
City 100, Taiwan R.O.C.
(02)33222777
http://www.ntub.edu.tw/bin/home.php
0052
National Pingtung University
No.4-18 Minsheng Rd., Pingtung City, Pingtung County (08)7663800
90003, Taiwan R.O.C.
1001
Tunghai University
No.1727, Sec.4, Taiwan Boulevard, Xitun District,
Taichung 40704, Taiwan R.O.C.
(04)23590121
http://www.thu.edu.tw
1002
Fu Jen Catholic University
510, Zhongzheng Rd.,Xinzhuang Dist, New Taipei City
24205, Taiwan, R.O.C.
(02)29052000
http://www.fju.edu.tw
1003
Soochow University
Chung Yuan Christian University
70, Linshi Rd., Shihlin,Taipei, Taiwan 111, R.O.C.
200 Chung Pei Road, Chung Li District, Taoyuan City,
Taiwan 32023, R.O.C.
(02)28819471
http://www.scu.edu.tw
1004
(03)2659999
http://www.cycu.edu.tw
1005
Tamkang University
No.151, Yingzhuan Rd., Tamsui Dist., New Taipei City
25137, Taiwan, R.O.C.
(02)26215656
http://www.tku.edu.tw
1006
Chinese Culture University
55, Hwa-Kang Road, Yang-Ming-Shan, Taipei , Taiwan
11114, R. O. C.
(02)28610511
http://www.pccu.edu.tw
1007
Feng Chia University
(04)24517250#2258 http://www.fcu.edu.tw
1008
Providence University
No. 100 Wenhwa Rd., Seatwen, Taichung, Taiwan
40724, R.O.C.
200, Sec. 7, Taiwan Boulevard, Shalu Dist., Taichung
City 43301 Taiwan ,R.O.C.
(04)26328001
http://www.pu.edu.tw
1009
Chang Gung University
No.259, Wenhua 1st Rd., Guishan Dist., Taoyuan City
33302, Taiwan R.O.C.
(03)2118800
http://www.cgu.edu.tw
135 Yuan-Tung Road, Chung-Li, Taiwan 32003, R.O.C.
707, Sec.2, WuFu Rd., HsinChu, Taiwan 300, R.O.C.
No.168, University Rd., Dacun, Changhua 51591,
Taiwan R.O.C.
No. 1, Huafan Rd. Shihding Dist., New Taipei City 223,
Taiwan R.O.C.
(03)4638800
http://www.yzu.edu.tw
(03)5374281
http://www.chu.edu.tw
(04)8511888
http://www.dyu.edu.tw
(02)26632102
http://www.hfu.edu.tw
1010
Yuan Ze University
1011 Chung Hua University
1012 Dayeh University
http://www.nptu.edu.tw
1013
Huafan University
1014
I-Shou University
No.1, Sec. 1, Syuecheng Rd., Dashu District, Kaohsiung
City 84001,Taiwan, R.O.C.
(07)6577711
http://www.isu.edu.tw
1015
Shih Hsin University
Ming Chuan University
1, Lane 17, Sec. 1, Mu-Cha Rd.,Taipei,Taiwan, R.O.C.
250 Zhong Shan N. Rd., Sec. 5, Taipei 111, Taiwan
R.O.C.
(02)22368225
http://www.shu.edu.tw
(02)28824564
http://www.mcu.edu.tw
1016
17
1017
Shih Chien University
No.70, Dazhi St., Zhongshan Dist., Taipei City 104,
Taiwan, R.O.C.
(02)25381111
http://www.usc.edu.tw
1018
Chaoyang University of Technology
168, Jifeng E. Rd., Wufeng District, Taichung, 41349
Taiwan, R.O.C.
(04)23323000
http://www.cyut.edu.tw
1019
Kaohsiung Medical University
(07)3121101
http://www2.kmu.edu.tw/front/bin/home.phtml
1020
Nanhua University
100,Shih-Chuan 1st Road,Kaohsiung,80708,Taiwan ,
R.O.C.
No. 55, Sec. 1, Nanhua Rd., Dalin Township, Chiayi
County 62249, Taiwan , R.O.C.
(05)2721001
http://www.nhu.edu.tw
1021
Aletheia University
No.32, Zhenli St., Danshui Dist., New Taipei City
25103, Taiwan, R.O.C.
(02)26212121
http://www.au.edu.tw
1022
Tatung University
No.40, Sec. 3,Zhongshan N. Rd., Taipei City 104,
Taiwan, R.O.C
(02)21822928
http://www.ttu.edu.tw
1023
Southern Taiwan University of Science
and Technology
No. 1, Nan-Tai Street, Yongkang Dist., Tainan City 710,
Taiwan R.O.C.
(06)2533131
http://www.stust.edu.tw
1024
Kun Shan University
No.195, Kunda Rd., YongKang Dist., Tainan City 71003, Taiwan, R.O.C.
(06)2727175
http://www.ksu.edu.tw
1025
Chia Nan University of Pharmacy &
Science
No.60, Sec. 1, Erren Rd., Rende Dist., Tainan City
71710, Taiwan , R.O.C.
(06)2664911
http://www.chna.edu.tw
1026
Shu-Te University
59, Hengshan Rd., Yanchao Dist. ,Kaohsiung City,82445 (07)6158000
Taiwan, R.O.C.
http://www.stu.edu.tw
1027
Tzu Chi University
(03)8565301
http://www.tcu.edu.tw
1028
Taipei Medical University
Chung Shan Medical University
No.701, Sec. 3, Zhongyang Rd. Hualien 97004, Taiwan ,
R.O.C.
250 Wuxing Street, Taipei City, TAIWAN 110, R.O.C.
No.110,Sec.1,Jianguo N.Rd.,Taichung City
40201,Taiwan, R.O.C.
(02)27361661
http://www.tmu.edu.tw
(04)24730022
http://www.csmu.edu.tw
1029
1030
Lunghwa University of Science and
Technology
No.300,Sec.1,Wanshou Rd.,Guishan District,Taoyuan
City, 33306,Taiwan R.O.C.
(02)82093211
http://www.lhu.edu.tw/
1031
Fooyin University
151 Jinxue Rd., Daliao Dist., Kaohsiung City 83102 ,
Taiwan, R.O.C.
(07)7811151
http://www.fy.edu.tw
1032
Minghsin University of Science and
Technology
No.1, Xinxing Rd., Xinfeng Hsinchu 30401, Taiwan
R.O.C.
(03)5593142
http://www.must.edu.tw
1033
Chang Jung Christian University
No.1,Changda Rd.,Gueiren District, Tainan City 71101,
Taiwan R.O.C.
(06)2785123
http://www.cjcu.edu.tw
1034
Hungkuang University
No. 1018, Sec. 6, Taiwan Boulevard, Shalu District,
Taichung City 43302, Taiwan R.O.C.
(04)26318652
http://www.hk.edu.tw
1035
China Medical University
(04)22053366
http://www.cmu.edu.tw
1036
Chien Hsin University of Science and
Technology
No.91 Hsueh-Shih Road,Taichung, Taiwan 40402,
R.O.C.
No.229, Jianxing Rd., Zhongli District, Taoyuan City
32097, Taiwan R.O.C.
(03)4581196
http://www.uch.edu.tw
1037
Cheng Shiu University
No.840, Chengcing Rd., Niaosong Dist., Kaohsiung City
83347, Taiwan R.O.C.
(07)7358800
http://www.csu.edu.tw/main.php
18
1038
Vanung University
No.1, Wanneng Rd., Zhongli Dist., Taoyuan City 32061,
Taiwan R.O.C.
(03)4515811
http://www.vnu.edu.tw/
1039
Hsuan Chuang University
(03)5302255
http://www.hcu.edu.tw
1040
Chienkuo Technology University
48, Hsuan Chuang Road, Hsinchu City, Taiwan 300 ,
R.O.C.
No.1,Chiehshou North Road, Changhua City 500,
Taiwan, R.O.C.
(04)7111111
http://www.ctu.edu.tw
1041
Ming Chi University of Technology
84 Gungjuan Rd., Taishan Dist. New Taipei City 24301,
Taiwan R.O.C.
(02)29089899
http://www.mcut.edu.tw/
1042
Kao Yuan University
No.1821, Jhongshon Rd., Lujhu Dist., Kaohsiung City
82151, Taiwan R.O.C.
(07)6077777
http://www.kyu.edu.tw/kyunew3/index3.html
1043
Tajen University
No.20, Weixin Rd., Yanpu Township, Pingtung County
90741, Taiwan R.O.C.
(08)7623924
http://www.tajen.edu.tw
1044
St. John's University
499, Sec. 4, Tam King Road,Tamsui District, New
Taipei City, 25135 Taiwan, R.O.C.
(02)28013131
http://www.sju.edu.tw/
1045
Ling Tung University
China University of Technology
1, Ling tung Rd., Taichung, Taiwan, R.O.C.
No. 56, Sec. 3, Xinglong Rd., Wunshan District, Taipei
City 116, Taiwan R.O.C.
(04)23892088
http://www.ltu.edu.tw
(02)29313416
http://www.cute.edu.tw/
1047
Central Taiwan University of Science
and Technology
No.666, Buzih Rd., Beitun District, Taichung City
40601, Taiwan, R.O.C.
(04)22391647
http://www.ctust.edu.tw
1048
Asia University
http://www.asia.edu.tw
1049
Kainan University
500, Lioufeng Rd., Wufeng, Taichung 41354, Taiwan R. (04)23323456
O. C.
(03)3412500
No.1 Kainan Road, Luzhu Dist., Taoyuan City 33857,
Taiwan, R.O.C
1050
Fo Guang University
1051
Tainan University of Technology
1052
Far East University
1046
http://www.knu.edu.tw
No.160, Linwei Rd., Jiaosi , Yilan County 26247,
Taiwan R.O.C.
No.529, Zhongzheng Rd., Yongkang District, Tainan
City 71002, Taiwan R.O.C.
(03)9871000
http://www.fgu.edu.tw
(06)2532106
http://www.tut.edu.tw/
No.49, Zhonghua Rd., Xinshi Dist., Tainan City 74448,
Taiwan , R.O.C.
(06)5979566
http://www.feu.edu.tw
Yuanpei University of Medical
Technology
1054 Jinwen University of Science and
Technology
No.306, Yuanpei St., HsinChu, Taiwan 30015, R.O.C
(03)5381183
http://epage.ypu.edu.tw/bin/home.php
No.99, Anzhong Rd., Xindian Dist., New Taipei City
23154, Taiwan ,R.O.C.
(02)82122000
http://www.just.edu.tw/
1055
Chung Hwa University of Medical
Technology
No.89, Wenhwa 1st St., Rende Shiang, Tainan County
717, Taiwan R.O.C.
(06)2674567
http://www.hwai.edu.tw
1056
Tungnan University
No.152, Sec. 3, Beishen Rd., Shenkeng Dist., New
Taipei City 222, Taiwan R.O.C.
(02)86625900
http://www.tnu.edu.tw/
1057
Takming University of Science and
Technology
No.56, Sec.1, Huanshan Rd., Neihu District,Taipei City,
Taiwan 11451, R.O.C.
(02)26585801
http://www.takming.edu.tw
1058
Mingdao University
No.369, Wen-Hua Rd.,Pettow, ChangHua 52345
,Taiwan ,R.O.C
(04)8876660
http://www.mdu.edu.tw
1053
19
1060
Nan Kai University of Technology
No.568, Zhongzheng Rd., Caotun Township, Nantou
County 54243, Taiwan R.O.C.
(049)2563489
http://www.nkut.edu.tw
1061
China University of Science and
Technology
No.245, Academia Rd. Sec. 3, Nangang Dist., Taipei
City 115, Taiwan R.O.C.
(02)27821862
http://www.cust.edu.tw/www/cust.html
1062
Overseas Chinese University
Yu Da University of Science and
Technology
100,Chiao Kwang Rd., Taichung 40721, Taiwan, R.O.C.
No. 168, Hsueh-fu Rd., Tanwen Village, Chaochiao
Township, Miaoli County, 361 Taiwan, R.O.C
(04)27016855
http://www.ocu.edu.tw
(037)651188
http://www.ydu.edu.tw
Meiho University
Wufeng University
23, Pingguang Rd., Neipu, Pingtung, Taiwan, R.O.C.
117, Sec 2, Chiankuo Rd, Minhsiung, Chiayi County
62153, Taiwan, R.O.C.
(08)7799821
http://www.meiho.edu.tw
1065
(05)2267125
http://www.wfu.edu.tw/wufeng/
1066
TransWorld University
No.1221, Zhennan Rd., Douliu City, Yunlin County 640, (05)5370988
Taiwan R.O.C.
http://www.twu.edu.tw/
1067
Taiwan Shoufu University
(06)5718888
http://www.tsu.edu.tw/
1068
Chung Chou University of Science and
Technology
No.168,Nanshi Li,Madou Dist.,Tainan City,Taiwan,
R.O.C.
No. 6, Lane 2, Sec. 3, Shanjiao Rd., Yuanlin City,
Changhua County 510, Taiwan, R.O.C.
(04)8359000
http://www.ccut.edu.tw
1069
Hsiuping University of Science and
Technology
No.11 Gongye Rd, Dali Dist., Taichung City 41280,Taiwan,R.O.C.
(04)24961100
http://www.hust.edu.tw/
1070
Chang Gung University of Science and
Technology
No.261, Wenhua 1st Rd., Guishan Dist., Taoyuan City
33303, Taiwan R.O.C.
(03)2118999
http://new.cgust.edu.tw/front/bin/home.phtml
1071
Taipei City University of Science and
Technology
No. 2, Xueyuan Rd., Beitou, 112 Taipei, Taiwan, R.O.C.
(02)28927154
http://www.tpcu.edu.tw
1072
Ta Hwa University of Science and
Technology
No.1, Dahua Rd., Qionglin Shiang, Hsinchu County 307, (03)5927700
Taiwan, R.O.C.
1073
Hsing Wu University of Science and
Technology
No. 101, Sec.1, Fenliao Rd., LinKou District, New
Taipei City 244, Taiwan R.O.C.
(02)26015310
http://www.hwu.edu.tw
1074
Nan Jeon University of Science and
Technology
No.178, Chaoqin Rd., Yanshui Dist., Tainan City 73746,
Taiwan R.O.C.
(06)6523111
http://www.nju.edu.tw
Wenzao Ursuline University of
Languages
1076 Hwa Hsia University of Technology
900 Mintsu 1st Road Kaohsiung 807, Taiwan R.O.C.
(07)3426031
http://www.wzu.edu.tw
No.111, Gongzhuan Rd., Zhonghe Dist., New Taipei
City 235, Taiwan R.O.C.
(02)89415100
http://www.hwh.edu.tw
1077
Tzu Chi University of Science and
Technology
880,Sec.2,Chien-kuo Rd.Hualien City ,Taiwan
970,R.O.C.
(03)8572158
http://www.tccn.edu.tw
1078
Chihlee University of Technology
313, Sec. 1, Wunhua Rd., Banciao District, New Taipei
City, 22050 Taiwan, R.O.C
(02)2257-6167 or
(02)2257-6168
http://www.chihlee.edu.tw
1079
University of Kang Ning
No.137, Lane 75, Sec. 3, Kangning Rd., Neihu District,
Taipei City 114, Taiwan, R.O.C.
(02)26328744
http://www.ukn.edu.tw/ukn/index.html
3002
University of Taipei
National Taiwan College of Performing
Arts
No.1,Ai-Guo West Road,Taipei,10048 Taiwan R.O.C.
177, Sec. 2, Neihu Rd.,Taipei, Taiwan, R.O.C.
(02)23113040
http://www.uTaipei.edu.tw
(02)27962666
http://www.tcpa.edu.tw/bin/home.php
1063
1064
1075
0144
20
http://www.tust.edu.tw
1125
CTBC Financial Management College
No.600, Sec. 3, Taijiang Blvd., Annan District, Tainan,
Taiwan 709,R.O.C.
(06)2873335
http://www.ctbc.edu.tw/
1148
Dahan Institute of Technology
No.1, Shuren St., Dahan Village, Xincheng Township,
Hualien County 97145, Taiwan , R.O.C.
(03)8210888
http://www.dahan.edu.tw
1159
Fortune Institute of Technology
No.288, chihshiue Rd., Daliao District, Kaohsiung City
831, Taiwan R.O.C.
(07)7889888
http://www.fotech.edu.tw
1166
Oriental Institute of Technology
58, Sihchuan Rd. Sec.2, Pan-Chiao District, New Taipei
City 22061,Taiwan, R.O.C.
(02)77388000
http://www.oit.edu.tw
1168
Taoyuan Innovation Institute of
Technology
NO.414,Sec.3, Jhongshan E. Rd., Zhongli District,
Taoyuan City 32091 Taiwan, R.O.C.
(03)4361070
http://www.tiit.edu.tw/home.aspx
1176
Toko University
No.51, Sec. 2, Xuefu Rd., Puzi City, Chiayi County
61363, Taiwan, R.O.C.
(05)3622889
http://www.toko.edu.tw
1179
De Lin Institute of Technology
No.1, Ln. 380, Qingyun Rd., Tucheng Dist, New Taipei
City 236, Taiwan R.O.C.
(02)22733567
http://www.dlit.edu.tw
1182
Lan Yang Institute of Technology
No.79, Fushin Rd., Touchen Town, Yilan County 26141, (03)9771997
Taiwan, R.O.C.
http://www.fit.edu.tw
1183
Lee-Ming Institute of Technology
No.22, Sec. 3, Tailin Rd., Taishan Dist., New Taipei City (02)29097811
243, Taiwan , R.O.C.
http://www.lit.edu.tw
1184
Tung Fang Design of University
No.110, Dongfang Rd., Hunei District, Kaohsiung City
82941, Taiwan, R.O.C.
(07)6932011
http://www.tf.edu.tw
1185
Ching Kuo Institute of Management and
Health
No.336, Fu Hsin Rd.,Keelung, Taiwan, R.O.C.
(02)24372093
http://www.cku.edu.tw
1187
Chungyu Institute of Technology
No.40, Yi 7th Rd., Xinyi Dist., Keelung City 20103,
Taiwan , R.O.C.
(02)24237785
http://www.cit.edu.tw/
Tatung Institute of Technology
Asia - Pacific Institute of Creativity
1192 Taiwan Hospitality and Tourism College
253 Mi-Tuo Road, Chiayi City, Taiwan R.O.C.
No.110, XueFu Rd. Toufen, Miaoli 351, Taiwan R.O.C
No.268, Zhongxing St., Shoufeng Township, Hualien
County 974, Taiwan R.O.C.
(05)2223124
http://www.ttc.edu.tw
(037)605500
http://w2.apic.edu.tw/
(03)8653906
http://www.tht.edu.tw
1195
Mackay Medical College
No.46, Sec. 3, Zhongzheng Rd., Sanzhi Dist., New
Taipei City 252, Taiwan , R.O.C.
(02)26360303
http://www.mmc.edu.tw
1196
Dharma Drum Institute of Liberal Arts
No. 700, Fagu Rd., Jinshan Dist. New Taipei City 20842, (02) 24980707
Taiwan, R.O.C.
1197
Taipei College of Maritime Technology
No.150, Sec. 3, Binhai Rd., Tamsui Dist., New Taipei
City 25172, Taiwan R.O.C.
(02)28052088 or
(02)28102292
http://www.tcmt.edu.tw
0221
National Tainan Institute of Nursing
National Taitung Junior College
78, Sec. 2, Minzu Rd., Tainan City 700, Taiwan, R.O.C.
No.889, Jhengci N. Rd., Taitung, 95045 Taiwan, R.O.C.
(06)2110600
http://www.ntin.edu.tw
(089)226389#6000
http://www.ntc.edu.tw
1282
Mackay Junior College of Medicine ,
Nursing and Management
No.92, Shengjing Rd., Beitou District, Taipei City 112,
Taiwan, R.O.C.
(02)28584180
http://www.mkc.edu.tw
1283
Jen-Teh Junior College of Medicine,
Nursing and Management
NO,79-9 Sha-Luen Hu Xi-Zhou Li Hou-Loung Town,
Miaoli County, R.O.C.
(037)728855
http://www.jente.edu.tw
1188
1189
0222
21
http://www.dila.edu.tw/
1284
Shu-Zen Junior College of Medicine and
Management
No.452, Huanqiu Rd., Luzhu Dist.,Kaohsiung City
82144, Taiwan, R.O.C.
(07)6979333
http://www.szmc.edu.tw
1285
Tzu Hui Institute of Technology
No.367, Sanmin Rd. Nanjhou Hsian, Pingtung County,
926, Taiwan R.O.C.
(08)8647367
http://www.tzuhui.edu.tw
1286
Cardinal Tien Junior College of
Healthcare & Management
No. 112, Minzu Road, Sindian District. New Taipei City
23143, Taiwan R.O.C.
(02)22191131
http://www.ctcn.edu.tw
1287
Min-Hwei Junior College of Health Care
Management
No.1116, Sec. 2, Zhongshan E. Rd., Liuying Township,
Tainan County 736, Taiwan R.O.C.
(06)6226111
http://www.mhchcm.edu.tw/
1288
KaoMei Junior College of Health Care &
Management
No.309, Chenggong Rd., Meinong Dist., Kaohsiung city
843,Taiwan R.O.C.
(07)6812148
http://www.kmvs.khc.edu.tw/
1289
Yuh-Ing Junior College of Health Care &
Management
No.15 Lane 420 Dachang 2nd Rd. Sanmin District,
Kaohsiung City 807 Taiwan, R.O.C.
(07)3811765
http://163.15.186.16/releaseRedirect.do?unitID=1
1290
Chung-Jen Junior College of Nursing,
Health Sciences and Management
No 217, Hung-Mao-Pi, Chia-Yi City, Taiwan 60077,
ROC.
(05)2773932
http://www.cjc.edu.tw
1291
St. Mary's Junior College of Medicine,
Nursing and Management College
No.100, Ln. 265, Sec. 2, Sanxing Rd., Sanxing
Township, Yilan County 266, Taiwan R.O.C.
(03)9897396
http://www.smc.edu.tw/
1292
Hsin Sheng Junior College of Medical
Care and Management
No.418,Gaoping Sec., Jhongfong Rd., Longtan District,
Taoyuan City 32544, Taiwan R.O.C.
(03)4117578
http://www.web.hsc.edu.tw/bin/home.php
1R02
Taiwan Baptist Christian Seminary
(02) 27239500
http://www.tbts.edu.tw/
1R03
Christ's College Taipei
No. 1 Lane 394 Wu Xing Street, 110 Taipei, Taiwan,
R.O.C.
No.51, Ziqiang Rd., Tamsui Dist., New Taipei City
25162, Taiwan, R.O.C.
(02)28097661
http://www.cct.edu.tw/
1R04
I-Kuan Tao College
No.81, Sanmin Rd. Liugui Dist., Kaohsiung City 84442,
Taiwan R.O.C.
(07)-6872139
http://www.iktc.edu.tw
0A01
National Open University
No.172, Zhongzheng Rd., Luzhou Dist., Xinbei City
247, Taiwan R.O.C.
(02)22829355
http://www.nou.edu.tw
3A01
Open University of Kaohsiung
No. 436, Daye North Rd., Siaogang Dist., Kaohsiung
City, Taiwan R. O. C.
(07)8012008
http://www.ouk.edu.tw
22
健康檢查證明應檢查項目表（乙表）
醫院標誌
Hospital’s
Logo
檢查日期 ____/____/____
（醫院名稱、地址、電話、傳真機）
ITEMS REQUIRED FOR HEALTH CERTIFICATE （Form B）
（Hospital’s Name, Address, Tel, FAX）
基
本
姓 名 ：
Name
_________________
身份證字號
： _________________
ID No.
出生年月日
Date of Birth
：
年齡
Age
： _________________
實
/
–––
驗
–––
室
/
檢
–––
資
料
(年) (月) (日)
____/____/____
(Ｍ) (Ｄ) (Ｙ)
Date of Examination
( BASIC DATA)
性別 ： □男 Male □女 Female
Sex
護照號碼
： _________________
Passport
No.
國籍
Nationality ： _________________
照片
Photo
聯絡電話
Phone No. ： _________________
查 (LABORATORY EXAMINATIONS)
A. HIV 抗體檢查（Serological Test for HIV Antibody）
：
□陽性（Positive）
□陰性（Negative）
ａ.篩檢（Screening Test）： □EIA
□PA
□未確定（Indeterminate）
□其他（Others）______________
ｂ.確認（Confirmatory Test）
：□Western Blot
□其他（Others）______________
□兒童 15 歲以下免驗 (Not required for children under 15 years of age)
B. 胸部 X 光檢查肺結核（Chest Ｘ-Ray for Tuberculosis）
：
X 光發現(Findings)：
判定(Results)：
□合格(Passed)
□疑似肺結核(TB Suspect)
□無法確認診斷( Pending)
□不合格(Failed)
(經臺灣健檢醫院判定為疑似肺結核或無法確認診斷者，得至指定機構複驗；但所在縣市無指定機
構者，得至鄰近醫院之胸腔科門診複檢。) (Those who are determined to be TB suspects or have a
pending diagnosis by the designated hospital in Taiwan must visit the referred institution for further
evaluation.)
□孕婦或兒童 12 歲以下免驗 (Not required for pregnant women or children under 12 years of age)
C.腸內寄生蟲（含痢疾阿米巴等原蟲）糞便檢查（採用離心濃縮法檢查）
（Stool examination for parasites
includes Entameba histolytica etc.）(centrifugal concentration method)：
□陽性，種名( Positive, Species ) ______________________ □陰性（Negative）
□其他可不予治療之腸內寄生蟲(Other parasites that do not require treatment) ____________________
□兒童 6 歲以下或來自特定地區者免驗 (Not required for children under 6 years of age or applicants
from designated areas as described in Note 6)
D.梅毒血清檢查（Serological Test for Syphilis）
：
檢驗(Tests)：ａ.□RPR 或□VDRL ______________ ｂ.□TPHA/TPPA _______________
ｃ.□其它（Other）___________
判定(Results)：□合格(Passed)
□不合格(Failed)
□兒童 15 歲以下免驗 (Not required for children under 15 years of age)
E.麻疹及德國麻疹之抗體陽性檢驗報告或預防接種證明（proof of positive measles and rubella antibody
titers or measles and rubella vaccination certificates）
：
a.抗體檢查（Antibody test )
麻疹抗體 measles antibody titers
□陽性 Positive
□陰性 Negative □未確定（Equivocal）
德國麻疹抗體 rubella antibody titers □陽性 Positive
□陰性 Negative □未確定（Equivocal）
b.預防接種證明 Vaccination Certificates
(含接種日期、接種院所及疫苗批號；接種日期與出國日期應至少相隔兩週。)
(The Certificate should include the date of vaccination, the name of administering hospital or clinic and
the batch no. of vaccine; the date of vaccination should be at least two weeks prior to going abroad)
□麻疹預防接種證明 Vaccination Certificates of Measles
□德國麻疹預防接種證明 Vaccination Certificates of Rubella
c. □經醫師評估，有接種禁忌者，暫不適宜接種。(Having contraindications, not suitable for vaccination)
漢 生 病 檢 查（EXAMINATION FOR HANSEN’S DISEASE）
全身皮膚視診結果(Skin Examination)
□正常 Normal
□異常 Abnormal：○非漢生病 (not related to Hansen’s disease)：
○漢生病(疑似個案須進一步檢查)(Hansen’s disease suspect needs further exam)
ａ.病理切片(Skin Biopsy)：
ｂ.皮膚抹片(Skin Smear)：○陽性 ( Finding bacilli in affected skin smears )
○陰性（Negative）
c.皮膚病灶合併感覺喪失或神經腫大( Skin lesions combined with sensory loss
or enlargement of peripheral nerves ) ○有（Yes） ○無（No）
判定(Results)：□合格(Passed)
□不合格(Failed)
□來自特定地區者免驗 (Not required for applicants from designated areas as described in Note 6)
備註(Note)：
一、本表供外籍人士、無戶籍國民、大陸地區人民及香港澳門居民申請在臺灣居留或定居時使用。This form is for
residence application.
二、兒童 6 歲以下免辦理健康檢查，但須檢具預防接種證明備查(年滿 1 歲以上者，至少接種 1 劑麻疹、德國麻疹疫
苗)。 A child under 6 years old is not necessary to have laboratory examination, but the certificate of vaccination is
necessary. Child age one and above should get at least one dose of measles and rubella vaccines.
三、懷孕婦女及兒童 12 歲以下免接受「胸部Ｘ光檢查」；懷孕婦女於產後仍應補照胸部 X 光。 Pregnant women and
children under 12 years of age are exempted from chest X-ray examination. Pregnant women should undergo chest
X-ray after the child’s birth.
四、申請免除胸部 X 光檢查之適用對象：申請人限來自結核病盛行率低於十萬分之三十的國家，並檢具由精神科醫
師出具申請人在心理上不適合進行胸部 X 光檢查之診斷證明書，經行政院衛生署疾病管制局審核通過者，始得
免除此項檢測。
五、兒童 15 歲以下免接受「HIV 抗體檢查」及「梅毒血清檢查」
。 A child under 15 years old is not necessary to have
Serological Test for HIV or Syphilis.
六、居住於美國、加拿大、歐洲、紐西蘭、澳洲、日本、南韓、香港、澳門、新加坡及以色列等地區或國家之申請
者，得免驗腸內寄生蟲糞便檢查及漢生病檢查。 Applicants living in USA, Canada, Europe, New Zealand, Australia,
Japan, South Korea, Hong Kong, Macao, Singapore or Israel are not required to undergo a stool examination for
parasites or an examination for Hansen’s disease.
七、漢生病檢查為全身皮膚檢查，受檢者可穿著內衣內褲，並由親友或女性醫護人員陪同受檢。檢查時逐步分部位
受檢，避免一次脫光全身衣物，維護受檢者隱私。 Hansen’s disease examination refers to careful examination of the
entire body surface, which should be done with courtesy and respect to the applicant’s privacy. During the examination,
the applicant is allowed to wear underwear and be accompanied by a friend or female medical personnel. Hospitals or
clinics have the responsibilities to protect the privacy of the applicant and the examination should be done step by step.
Hence, taking off all clothes at the same time should be avoided.
八、根據以上對
先生/女士/小姐之檢查結果為
□合格
□不合格 □須進一步檢查
Result：According to the above medical report of Mr./Mrs./Ms.
, he/she
□has passed the examination □has failed the examination □needs further examination.
負 責 醫 檢 師 簽 章 ：
(Chief Medical Technologist)
負 責 醫 師 簽
( Chief Physician )
章
（Name ＆ Signature）
：
（Name ＆ Signature）
醫 院 負 責 人 簽 章
：
( Superintendent )
（Name ＆ Signature）
日期（Date）：
/
/
本證明三個月內有效（Valid for Three Months）
附錄：健康檢查證明不合格之認定原則
檢查項目
不合格之認定原則
人類免疫缺乏病 一、人類免疫缺乏病毒抗體檢驗經初步測試，連續二次呈陽性反應者，應以西方墨點法(WB)作確
毒抗體檢查
認試驗。
二、連續二次(採血時間需間隔三個月)西方墨點法結果皆為未確定者，視為合格。
胸部Ｘ光檢查 一、活動性肺結核(包括結核性肋膜炎)視為「不合格」
。
二、非活動性肺結核視為「合格」
，包括下列診斷情形：纖維化(鈣化)肺結核、纖維化(鈣化)病灶及
肋膜增厚。
腸內寄生蟲糞便 一、經顯微鏡檢查結果為腸道蠕蟲蟲卵或其他原蟲類如：痢疾阿米巴原蟲（Entamoeba histolytica）、
檢查
鞭毛原蟲類，纖毛原蟲類及孢子蟲類者為不合格。
二、經顯微鏡檢查結果為人芽囊原蟲及阿米巴原蟲類，如：哈氏阿米巴（Entamoeba hartmanni）、
大腸阿米巴（Entamoeba coli）、微小阿米巴（Endolimax nana）、嗜碘阿米巴（Iodamoeba
butschlii）、雙核阿米巴（Dientamoeba fragilis）、唇形鞭毛蟲(Chilomastix mesnili)等，可不予治
療，視為「合格」
。
三、妊娠孕婦如為寄生蟲檢查陽性者，視為合格；請於分娩後，進行治療。
梅毒血清檢查 一、以 RPR 或 VDRL 其中一種加上 TPHA(TPPA)之檢驗，如檢驗結果有下列情形任一者，為「不
合格」：
（一）活性梅毒：同時符合條件（一）及（二）、或僅符合條件（三）者。
（二）非活性梅毒：僅符合條件（二）者。
二、條件：
（一）臨床症狀出現硬下疳或全身性梅毒紅疹等臨床症狀。
（二）未曾接受梅毒治療或病史不清楚者，RPR(+)或 VDRL(+)，且 TPHA (TPPA)=1：320 以上（含
320）
。
（三）曾經接受梅毒治療者，VDRL 價數上升四倍。
三、梅毒血清檢查陽性者，檢具治療證明，視為合格。
麻疹、德國麻疹 麻疹、德國麻疹抗體檢查結果為陰性(或未確定者)，且未檢具於抗體檢查後之麻疹、德國麻疹預防
接種證明者，視為不合格。但經醫師評估有麻疹、德國麻疹疫苗接種禁忌者，視為合格。
Appendix: Principles in determining the health status failed
Test Item
Principles on the determination of failed items
Serological Test 1. If the preliminary testing of the serological test for HIV antibody is positive for two consecutive times,
for HIV
confirmation testing by WB is required.
Antibody
2. When findings of two consecutive WB testing (blood specimens collected at an interval of three
months) are indeterminate, this item is considered qualified.
Chest X-ray
1. Active pulmonary tuberculosis (including tuberculous pleurisy) is unqualified.
2. Non-active pulmonary tuberculosis including calcified pulmonary tuberculosis, calcified foci and
enlargement of pleura, is considered qualified.
Stool
1. By microscope examination, cases are determined unqualified if intestinal helminthes eggs or other
Examination for protozoa such as Entamoeba histolytica, flagellates, ciliates and sporozoans are detected.
Parasites
2. Blastocystis hominis and Amoeba protozoa such as Entamoeba hartmanni, Entaboeba coli, Endolimax
nana, Iodamoeba butschlii, Dientamoeba fragilis, Chilomastix mesnili found through microscope
examination are considered qualified and no treatment is required.
3. Pregnant women who have positive result for parasites examination are considered qualified and
please have medical treatment after the child’s birth.
Serological Test 1. After testing by either RPR or VDRL together with TPHA(TPPA), if cases meet one of the following
for Syphilis
situations are considered failing the examination.
(1)Active syphilis: must fit the criterion (1) + (2) or only the criterion (3).
(2)Inactive syphilis: only fit the criterion (2).
2. Criterion:
(1)Clinical symptoms with genital ulcers (chancres) or syphilis rash all over the body.
(2)No past diagnosis of syphilis, a reactive nontreponemal test (i.e., VDRL or RPR), and
TPHA(TPPA)＝1：320↑(including 1：320)
(3)A past history of syphilis therapy and a current nontreponemal test titer demonstrating fourfold or
greater increase from the last nontreponemal test titer.
3. Those that have failed the serological test for syphilis but have submitted a medical treatment
certificate are considered passing the examination.
Measles,
The item is considered unqualified if measles or rubella antibody is negative (or equivocal) and no
Rubella
measles, rubella vaccination certificate issued after the antibody test is provided. Those who having
contraindications, not suitable for vaccinations are considered qualified.
03/06/2012