銘傳大學確診者資料調查(桃園校區)Survey Questions of MCU Confirmed Cases (Taoyuan Campus)
【個資宣告】本表單蒐集之個人資料,僅限於防疫業務、協助公部門調查或執行業務及法令需求等目的存續期間所需之必要範圍與地區內,供業務相關人員處理及利用。您將享有個資法第3條規定的五項權利,並可至「銘傳大學個人資料保護專區」(http://pims.mcu.edu.tw 進一步瞭解本校的個資管理政策、法規與個資連絡窗口。

The information collected on this form is only used in the range and region required for the purposes of epidemic prevention  and relevant affairs, assistance with government units’ investigation, implementation and legal requirements ; the period of keeping the information on file is based upon the activity. You will have rights in accordance with Item 5, Article 3 of Personal Information Protection Act. Please refer to MCU Guidelines for Personal Information Protection Management and MCU Personal Information Management System at URL (http://pims.mcu.edu.tw) for further understanding of MCU personal information management policy, regulations and contact information.
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以下請填寫自己的相關資訊Please write down your information
學號Student ID *
系所班級Department/ Program/Class *
姓名Name *
出生日期 Date of Birth(yyyy/mm/dd) *
MM
/
DD
/
YYYY
性別Gender
Clear selection
國籍Nationality *
確診日期 Date of positive result (yyyy/mm/dd) *
MM
/
DD
/
YYYY
身分證字號(居留證/護照)ID Number (ARC/Passport) *
隔離地址Address of quarantine *
家裡、宿舍名稱或是租屋地址,包含縣市及鄉鎮市區 Home, name of dormitory or rental address, including cities, counties, townships and districts.
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