國立中央大學學生更改個人資料申請表

NCU Application Form for Changing Personal Information

學生姓名 Name	(更改姓名者請填原姓名)	學號 Student ID No.	系所 Department/Institute	年級 Grade
更改項目 Items to Be Changed	姓名 Name	1.檢附戶籍謄本(現戶個人記事) A copy of your household certificate is required. 2.在校生：For current students: 檢附學生證Your student ID card is required. 新證類別Please choose a type of new student ID card. □悠遊卡學生證工本費NT$200元整 Student ID card with EasyCard functions: 200 NT dollars □ Mifare學生證(不具悠遊卡功能)工本費NT$100元整 Mifare Student ID Card (without EasyCard functions): 100 NT dollars 3.畢業生：For graduates: □檢附中文學位證書正本 The original copy of your Chinese diploma is required. □英文畢業證書若需更改姓名，可申請補發英文學位證明書(參看說明2) For changing your name on your English diploma, please apply for reissuing the English diploma (please refer to Instruction No. 2).
出生日期 Date of Birth	1.檢附戶籍謄本(現戶個人記事) A copy of your household certificate is required. 2.畢業生: For graduates: □檢附中文學位證書正本 The original copy of your Chinese diploma is required. □英文畢業證書若需更改出生日期，可申請補發英文學位證明書(參看說明2) For changing your date of birth on your English diploma, please apply for reissuing the English diploma (please refer to Instruction No. 2).
身分證字號 ID No.	1.檢附戶籍謄本(現戶個人記事)或居留證影本A copy of your household certificate or a copy of your ARC card is required. 2.民國101年3月前畢業生檢附中文學位證書正本For students who graduated by March 2012, the original copy of your Chinese diploma is required.
戶籍地址 Permanent Address	1.限在校生For current students only 2.檢附身分證影本A copy of your ID/ARC card (front and back sides) is required. 3.通訊地址為本校與學生書信暨公文往來之聯絡地址，如有更改，請務必至學籍系統更新。The permanent address is the contact address for students to receive official documents from NCU. If there is a change of address, please update it at NCU Portal.
其他 Others	請敘明更改項目並檢附相關證明文件： Please specify the items to be changed and attach the relevant documentation:
變更前Before Alteration
變更後After Alteration
申請人簽章 Applicant’s Signature	領取人簽章 Receiver’s Signature	□原有學生證換發新卡Receiving a reissued new student ID card □領回中文學位證書正本Receiving the original copy of the Chinese diploma
更改姓名者繳費 Payment (for the application for a name change)	註冊組經辦 Register Division	註冊組組長(或授權人) Chief of the Register Division (or Deputy)	更改姓名者後會課務組 Curriculum Division (for the application for a name change)
僅研究所在學生須辦理 For current postgraduates only

簽核順序：註冊組經辦→註冊組組長(或授權人)

Procedures: Register Division→ Chief of the Register Division (or Deputy)

說明：

依據學則第六十九條規定辦理。

英文畢業證書若需更改姓名或出生日期，可申請補發英文學位證明書，請至教務處網頁下載2-07 成績/證（明）書申請，需另付工本費100元。

Instructions:

The procedure was established per Article 69 of NCU Study Regulations.

1130918 If you need to change your name or your date of birth on your English diploma, you can apply for reissuing the English diploma. Please download Application Form 2-07 to apply for English/Chinese transcripts and degree certificates on the website of the Office of Academic Affairs. An administration fee of 100 NT dollars is required for the application.