Chaoyang University of Technology International Student’s Application for
Suspension of Schooling休學  Withdrawal from School退學	
Date:          (month/day/year)
Student Name
學生姓名		Student Number
學號		Program
學制	Four-year program四技 Two-year Program二技
Full-time Master’s Program碩士班
Doctoral Program博士班	
Department
/Year/Class系年班	Department/Institute                                              Year       Class 
        系                                                                      年            班	
Reasons of Application
申請原因		
Suspension Period
休學年限	 One Semester一學期          Academic Year      Semester	
	 One Academic Year一學年 from Academic Year      Semester     to Academic Year      Semester     	
Address of Parent
監護人地址		Parent’s Contact Number監護人電話：	
Signature of Student
學生簽章	

Mobile Number行動電話：	Signature of Parent家長簽章：	

Procedure 1
程序一	First interview by the Tutor
導師第一次訪談(簽註意見)	Second interview by the Tutor
導師第二次訪談(簽註意見)	
	Yes  No Recommended to arrange an interview with
the Student Development Center
建議與學生發展中心面談

Signature簽章：                   	

Signature簽章：                     	
	By Student Development Center 
學生發展中心	Leave this field blank if the Tutor marks “No” after the interview
導師訪談若勾「否」則學生發展中心免核章及簽註意見	
	By Department Office
系辦公室簽章	Signature and Comment of Department Director
系主任簽章(簽註意見)	
			
Admissions Section, Office of Academic Affairs教務處註冊組	Signature of Dean of Academic Affairs
教務長簽章	
Signature of Office
承辦人簽章	Signature of Director of Admissions Section
主任簽章		
			
Office hour：Monday to Friday, 08:00~17:00 

Chaoyang University of Technology International Student’s Application for
Suspension of Schooling休學  Withdrawal from School退學	

Please proceed in accordance with the order of the form

Date:          (month/day/year)
Student Name
學生姓名		Student Number
學號		Program
學制	Four-year program四技 Two-year Program二技
Full-time Master’s Program碩士班
Doctoral Program博士班	
Department
/Year/Class
系年班	Department/Institute                                              Year        Class 
        系                                                               年            班	
Procedure
程序	Transacting Unit
主辦單位	Transacting Matters
辦理事項	Transacting conditions
辦理情形	Signature of Officer
主辦人簽章	
Procedure 2
程序二	Section of Student Services
Office of International Affairs
3rd Floor, the Administration Building
國際事務處學生服務組
（行政大樓三樓）	National Health Insurance 全民健保			
Procedure 3
程序三	Student Guidance Section
1st Floor, the Administration Building
生活輔導組（行政大樓一樓）	Parking violation record、Parking permit refund
Yes No違規停車紀錄、停車證退費 			
	Housing Services Section
1st Floor ,the Dormitory Building
住宿服務組(第一宿舍一樓)	The student is a boarder
Yes No 是否為住宿生
Check-out procedure completed
Yes No 是否已辦理離宿驗收及保證金退費 			
	Extracurricular Activity Section
1st Floor ,the Dormitory Building
課外活動組(第一宿舍一樓)	The student is a club leader. 
Yes No 是否為社團負責人
Hand-over of the club properties completed. 
Yes No  社團財產是否移交			
Procedure 4
程序四	Campus Safety Center & Office of Military Instruction
1st Floor, the Administration Building
校安暨軍訓室（行政大樓一樓）	The student participates in the student group insurance during the suspension duration.
Yes No休學期間是否參加學生團體保險 			
Procedure 5
程序五	Office of Finance
4th Floor, the Administration Building
財務處(行政大樓四樓)	Issue payment receipt or proceed refund procedure
(Please attach the payment receipt if the payment has been paid.)開立繳費單或辦理退費手續			
Procedure 6
程序六	Bursary Section
1st Floor, the Administration Building
出納組(行政大樓一樓)	Payment of tuition or student group insurance fee.
繳交學雜費或學生團體保險費			
Procedure 7
程序七	Admissions Section, Office of
Academic Affairs
2nd Floor, the Administration Building
教務處註冊組(行政大樓二樓)	Book(s) return to the library or no fine is imposed.
Yes No圖書館借書已歸還或無罰款			
		Confirmation of Address.
No modification Modified核對監護人地址			
		Student ID EasyCard extension or cancellation
Yes No學生證悠遊卡展期或取消			
		Return of this Application Form
(This Application Form must be returned or else will be regarded as incompletion of suspension/withdrawal procedure.)			
Remarks: 
Students are required to complete the school-leaving procedures and this application form must be returned for the completion of suspension/withdrawal procedures. The Chaoyang University of Technology will issue a suspension certificate or an enrollment certificate (an enrollment certificate will be issued by the school for those who study for more than one semester and have score records).
Receive in person  Suspension Certificate   Withdrawal from School Certificate 
Signature:                                   By mail