國語日報語文中心華語組-線上課程報名表                                                 MDN Language Center-Registration form for online course
每份報名表限填一位學員資料 If you are registering more than one child, please fill in the form once per applicant
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Email *
學生中文姓名Student's Chinese Name *
Required
學生英文名字 *
Student's English Name .Please give your full name in a first name last name order, and same as on the passport.
生日 *
Date of Birth
MM
/
DD
/
YYYY
性別 *
Gender
國籍 *
Nationality
永久地址/僑居國 *
Permanent Address / Country of your residence
母語 *
Native Language
監護人資料 (姓名/電話/電子信箱/與學員的關係) . 報名者如係未滿16歲，必須詳實填寫監護人資料，並閱讀、了解相關規定。 *
Guardian Information(Name/Phone No/E-mai/Relationship).If the applicant is under the age of 16, guardian have to fill in detailed Guardian Information and read online course policy/rules.
上課用電子郵件(Gmail) *
Email for online course (Gmail)
線上課程地點/目前居住城市 *
Online Course Location or city   Ex: New York city
預計開始上課日 Estemated date to start course *
*一期課程為三個月或至少12堂課(每週至少一堂) Please be aware that the minimum of a session is 3 month-long or at least 12 classes (once a week).
MM
/
DD
/
YYYY
請選擇上課日數(Class Frequency) *
台北時間 Taipei time
Required
請選擇上課時段 Please choose your available time slot. *
台北時間 Taipei time
Required
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