[Chinese Version]

Xie Yu Education Foundation

Special Hardship Assistance Application

 

Name

 

 

Gender

 

 

Age

 

ID No.

 

Class & Department

 

 

Advisor Name

 

Family Address

 

Parent Names

 

The Reason You Apply for Special Hardship Assistance

 

Grades for the Recent Two Years

 

Selection Committee Comments

 

Board of Trustees Comments

 

Xie Yu Education Foundation 9/2005