【國立中山大學】學生校外賃居處所安全自主檢核表【  National Sun Yan-sen University  】Student Safety Self-Check Form for Off-campus Rental Premises
透過學生填報校外賃居處所安全自主檢核表，以強化學生校外賃居關懷安全訪視及緊急事件聯繫之用，以降低並減少學生賃居意外事件發生，達成家長放心、學生安心之目標，防範意外事端發生，關懷校外賃居生安全。
Through students’filling out the 「Student Safety Self-Check Form for Off-campus Rental Premises」 we aim to strengthen the off-campus rental housing safety visit and emergency contact for students.
We also strive to reduce the off-campus rental housing accidents in order to achieve the goal of reassuring both parents and students, preventing accidents and caring for the safety of off-campus rental students.

此問卷內容依據「教育部推動大專校院學生校外賃居安全暨服務工作注意事項」建立，
賃居工作注意事項於110年8月1日起適用。
The contents of this questionnaire are based on the
「Ministry of Education Guidelines for Promoting Safety and Services for Off-campus Rental Housing Among College and University Students」
which have been in effect since August 1, 2021.
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Email *
個資聲明及調查意義 ( 此說明學校編輯時可斟酌保留 )
個人資料蒐集、處理及利用告知聲明
Notice of Collection, Processing and Use of Personal Data  
 
本調查表符合個資法第16條規定之利用，所蒐集個資部分，係運用於校外賃居安全教育運用
This questionnaire complies with the provisions of Article 16 of the Personal Data Protection Act. The personal data collected shall be used for off-campus rental housing safety education. 

⚠️  本表單資料僅供教育部及本校服務賃居學生使用 ⚠️
The information on this form shall only be used by the Ministry of Education and the University’s service for students living in rental housing.

賃居調查的意義：與租屋者共同檢視租屋安全，盼能有效減少憾事發生。
The significance of the rental survey is to review rental safety with the renters in the hope of effectively reducing the occurrence of accidents. 未命名標題
系級
Department and Year。範例：電機2。  
 *
學號
Student ID Number。請確實填寫您的學號。
 *
姓名
Name。 請留下您的真實姓名。
 *
手機
Phone number。請填寫可連絡到您的號碼。範例：0912-345678。
 *
房東(或管理員)姓名
Name of landlord (or administrator)
 *
房東(或管理員)連絡電話
Landlord’s (or administrator’s) phone number
 *
賃居處建物類型
Type of building for rental housing
 *
賃居處其他賃居人身分
Identity of other tenants in the rental place
Clear selection
該賃居處建物(屬同一房東)出租房數？
The number of rental rooms in the rental building (belonging to the same landlord)?
Clear selection
租賃地址
Rental Address。
請填寫完整地址，包括鄉鎮之後的「街、路、村、里、巷、弄、號、樓、室」。
Please fill in your complete address

範例：高雄市鼓山區蓮海路70號
Example : No. 70, Lianhai Road, Gushan District, Kaohsiung City
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