Isian Contoh Formulir Korean Government Scholarship Program (KGSP)

[Form 1]

2014 대한민국정부초청 외국인 학부장학생 지원서 (Application for 2014 KGSP for an Undergraduate Degree  Please type or print clearly in i n English or Korean.

∙

 English Name Spelling MUST be exactly the same as in your passport

∙

 Please state a date in the following order year! month and day "ex. #anuary $%! &''( → &''()%&)$%*

∙

 +hoose up to $ preferred uni,ersities and departments "or ma-ors* respecti,ely

∙

 a department "or ma-or* only for a preferred uni,ersity 지원자명 성 (Family name) / 이름 (Given name) / Middle name

(Applicant’s name) 국적(Nationality)

생년월일(Birth-date)

(yyyy/mm/dd) 희망 계열

 인문사회(!umanities " #ocial #ciences)

(Desired Field of study)

 자연공학(Natural #ciences " $n%ineerin%) $n%ineerin%)  예체능(Arts and &hysical $ducation)

언어능력

국어(ore (orean an &rofic &roficien iency) cy)

 Advan Advanced ced  nterm ntermedi ediate ate  Be%inn Be%inner er

('an%ua%e &roficiency)

!어($n% ($n%li lish sh &ro &rofi fici cien ency cy))

 Adv Advan ance ced d  nt nter erme medi diat ate e  Be% Be%in inne nerr

"학 희망 #학(&referred *niv+)

,



.

희망 $공 (&referred Dept+)

,



.

#N$0 (111+2osnet+%o+2r) %&

6an you use this site in your country7 

 8es+  No+

34e%istration of #N$0(orean

)f yes9 have you re%istered as a mem:er7 

 8es+  No+

'an%ua%e #tudy on the internet)5

□ Checklist (Submission of Documents)

 Please put a  in the appropriate box! Type or Print clearly

∙

Required Documents

Original

Official

3 Copied

Document

 Notarized

Documents

Translation Yes

No

Yes

,

지원' One Complete Application Form

N/A



'(' One NIID !ledge

N/A

.

자)*+' One !ersonal "tatement

N/A

No

Yes

No

;

"학계,' One "tud# !lan

N/A

<

-.' $ / $ Recommendation %etters &from $ different recommenders'

N/A

=

자01234'

N/A

>

5%학6 789명' One )raduation Certificate of *ig+ sc+ool

?

5%학6 성적9명' One *ig+ sc+ool )rade Transcripts

@

:인 ; /< 국적 9명' One Certificate of Citizens+ip &Applicant , !arents'

,

국어 => !어 능력 공인 인9' & ?@자A '

One ! er sonal (edi cal Ass essment

One Certificate of -orean or nglis+ !roficienc#

C of -orean !roficienc#

N/A

C of nglis+ !roficienc#

N/A

&If applica.le' 0/3 □ 인적 사항 (Per!onal "nformation &nglis+ Name "pelling (1"T .e e2actl# t+e same as in #our passport'

성명

자국어

&Full Name'

&Natie

BC 사3 성&Famil# Name'

이름&)ien Name'

(iddle Name

&!assport !+oto' 3cm 45cm

language'

!어6 &nglis+'

성D &)ender'

□ (ale □ Female

성&Famil# Name'

이름&)ien Name'

(iddle Name

생년월일&Date of 7irt+8 ####/mm/dd' EFB/&(arital "tatus'

□ "ingle □ Married

G생지

BCHI

&!lace of 7irt+'

Cit#/!roince and Countr#

&Current !assport Num.er'

국적

BC JK)L

&Nationalit#'

&!assport 2piration date'

자M

N*

&*ome'

&(ailing

※!lease

9rite in N)%I"* ON%Y including street address: cit#: countr# and postal code

Address'

$O &!+one'

P#$O &Cell !+one'

Countr# Code / Area Code / !+one Num.er   ;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;  Countr# Code / Cell !+one Num.er 

이Q일 &
N* GR5%학6 &*ig+ "c+ool'

※!lease

9rite in N)%I"* ON%Y including street address: cit#: countr# and postal code

&(ailing Address'

$O &!+one'

Countr# Code / Area Code / !+one Num.er 

ST &Fa2'

Countr# Code / Area Code / Fa2 Num.er 

□ 언어능력 (#anguage Proficienc$

언어명

UV명

성적

UV일

&%anguage'

&Title of Test'

&"core or leel'

&Date of Test'

"W&%eel' 7eginning

Intermediate Adanced

국어 &-orean' !어 &nglis+'

□ 학력 (%ducation& including %lementar$ Sc'ool& !lease list most recent first

X학일

78일

)Y명

*Z지

&ntrance Date'

&)raduation Date'

&Institution'

&%ocation8 cit#/countr#'

& ####/mm/dd'

&####/mm/dd'

$/3 □ 고등학교 성적 (ig' Sc'ool Grade!) *nl$ for t'e !eme!ter! attended

학년

,학년 &0st #ear'

학년 &$nd #ear'

.학년 &3rd #ear'

백분율

+*+A#

&"c+ool Year'

(100 percentile

)rades &)!A' RAN- 

,-G-P-A-&

.100

/AK&

.100

□ !사항 (Famil$ acground

Y계

성명

생년월일

[8

\N지

&Relations+ip'

&Name8 Famil#/)ien/(iddle'

&Date of 7irt+'

&Occupation'

&Address8 district: cit#'

□ 한국"#$서 %& '( 장학) (Pre3iou! Sc'olar!'ip Aard! /ecei3ed from Korean in!titution!

]학^명

)L 연월일

지원 )Y

&Title of A9ard'

&!eriod8 ####/mm/dd'

&Institution'

∼

∼

□ *+ 한국$서, +- ./ 01 사2 (Pre3iou! 5i!it! to Korea

)L 연월일

지_

`적

\N => 체aYb)Y

&!eriod8 ####/mm/dd'

&Cit# or Region'

&!urpose of "ta#'

&Organization Concerned'

∼ ∼

□ 34인 56 (#i!t of /ecommender!

성명

지c

*d )Y명

$O

이Q일 N*

&Name'

&!osition'

&Organization'

&!+one'

&
T* AN"=R" I *A> )I>N A7O> AR TR1 AND CORRCT TO T* 7"T OF (Y -NO=%D) IF (Y AN"=R" CONTAIN ANY -IND OF FA%"*OOD: I =I%% TA- ANY %)A% R"!ON"I7I%ITY

DATE(yyyy/mm/dd):

NAME O T!E A""#$CANT

.

.

S$%NAT&'E O T!E A""#$CANT 3/3

[Form 2]

서7서 ("lede)

e> #f국 g/hi 학/]학생jk' lm 사no 지p qo '(rsl +

(1) 국 t #학u 학v %w' g xvw yz {|o l?' 학8} 연~w $•l + (2) 국u 사회€' c‚ƒ지 „…& †‡ˆ q이‰9 <Š g‹Œ‡(g‹`적u 회CUcwu Ž 09 g‹E사9 g‹적인 문C|언u ‘ %)o ƒ지 „>l+   (.) 국w' ’“ 3 ”(국t \N)L t) :인이 –—지5 ˜™l+   (;) 국어연" ; 학c}g "학} YbƒB 국š국™6›원이 g œw 어ž 이u… ™)ƒ지 „5 yŸl+ (<) 국š국™6›원이 g 학사†g ‹사nw 적¡ ¢ƒ5 이 W"l + (=) £k¤¥ ¦!§ ¨©ƒ\e ª g/ )Yu ©i이 «> ” :인u +인g¬ (이름9 연®9 *d 학6 %) 사¯w ‡ul+ §) 사no c‚ ”9 ]학생 지원'au )Z사n이 °c사±k ²명³ ”9 #학w' ´계® µ9 성적¶· % "학능력이 ¸l5 인g³ ”w> ]학^ 지¹o º지 @ƒ»z… 이u ™)ƒ 지 „o q—o '(rsl+

As a grantee of the 2014 Korean Government scholarship program for an undergraduate course,  pledge to a!ide !" the follo#ing rules$ (1)%o refrain from violation of universit" regulations, and to ful&ll m" o!ligations as a student to the !est of m" a!ilit"' (2)%o !ehave in a manner appropriate to the Korean culture and societ", and not to participate in an" form of political activit" (such as organiing a political part", oining a political part", attending political meetings, pu!lishing political articles and declarations, organiing or participating in demonstrations of a political nature, and so on)' (*) %o accept responsi!ilit" for pa"ing an" de!ts incurred in Korea (4) %o a!ide !" +-.s polic" concerning the Korean language course and the degree course #ithout an" o!ection' (/) %o a!ide !" all of the terms and regulations set !" +-' () %o agree to the use of m" personal information (name, contact num!er, institutions  !elong to, etc) #hen it is needed for the operation of the program or upon the reuest of other governmental institutions'

f  am proved to have violated an" of the a!ove articles, to have made a false statement in m" application documents or to have failed to compl" #ith academic standards or the rules of universit",  shall accept the decision of +-, even though it ma" include the suspension or revocation of the scholarship'

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[Form 6]

8"9:서 ("eson*l St*tement) <지U문 : 자)*+'•  2¼이지 이tk '½¾jk  ¿성 (A4, 4Àjk  ¿성   )ƒÁ   , Âàt¯o ÄŃ…& ƒ‰   , t¯o Æ Ç 

È " «…& ª이Éo ƒ\e 인ʃUË. 이 지U문Ì Í지 Î Ï™ƒUË.>



 oti'ations wit# w#ic# !ou appl! for t#is program  &ersonal $ac%ground in famil! and education  ignificant experiences !ou #a'e #ad* ris%s !ou #a'e ta%en and ac#ie'ements !ou #a'e made, persons or e'ents t#at  #a'e #ad a significant influence on !ou  +xtracurricular acti'ities suc# as clu$ acti'ities, communit! ser'ice acti'ities or wor% experiences  If applica$le, descri$e awards !ou #a'e recei'ed, pu$lications !ou #a'e made, or s%ills !ou #a'e acuired, etc.

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[Form 4]

%학;<서 (Study "l*n) <지U문 : 국어 => !어k  - ¼이지 이tk  A4 xЯ지w  4Àjk  ¿성ƒUË. "학계,'•  ¿성ƒ) $w 학6 |생Ñ} 

"학 `적} 계,w #? §uƒUÒ C]rsl . 이 지U문Ì Í지 Î Ï™ƒUË.>



성명 (Name)

Family name / Given name / Middle name

국적

생년월일

(Nationality)

(Date of Birthyyyy/mm/dd)

GR5%학6

X학일

(#econdary school

($ntry Date yyyy/mm)

attended)

78일 (Graduation Date yyyy/mm)

국어능력

Advanced ntermediate Be%inner)

(orean &roficiency)

!어능력

Advanced ntermediate Be%inner)

($n%lish &roficiency)

"학 희망 #학 (&referred *niversities) 희망 $공 (&referred Departments)

A

국X국 $ Î 학c}g "학w ¨© Ó국어&국어: !어 %' 능력o Ô§UÕ) c 계,

"tud# plans to improe foreign languages&-orean: nglis+: etc' required for ta?ing a .ac+elor@s degree course  /+01+ and A0"+ !ou come to orea.

B.

학c}g "학 계, (#학 ; $공 |M 이J9 학8 `‘Ö 계,9 "학 Î 계,o )Zƒ59 3학 희망 #학D $공이 lŸ ”w> µ ׃B )½ƒUË)

"tud# plan for a .ac+elor@s degree course & &lease state t#e reason !ou c#oose suc# uni'ersities and departments (or ma3ors), !our academic goals, specific plans (including timeline) to ac#ie'e t#em, and future plan after completion of !our  stud!. In case t#at preferred departments (or ma3ors) of t#e preferred uni'ersities are different, please mention a$out t#em  separatel!.)

-A%(""""mmdd)3

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+om ,-

#etter of /ecommendation / Type or print in English or Korean! not exceeding 0 pages in length. To be comleted by the *lic*nt:  &lease fill in !our name and ot#er information $elow. If possi$le, let !our recommender %now !our stud! plan in orea w#en as%  #im#er to write t#is letter. &lease note t#at recommendation letters t#at are not sealed and signed will not $e accepted.

Applicant@s Name8 Current/%ast &*ig+' "c+ool8 Date of 7irt+ &####/mm/dd' Desired Field of stud#


!referred 1niersities !referred Departments &or (aBors'

============================================================================================================== ========= To be comleted by the ecommende: 5our fran% and candid appraisal of t#e applicant will $e #ig#l! appreciated in t#e process of selection of orean 6o'ernment  c#olars#ip recipients and t#e admissions to a orean uni'ersit!. &lease ma%e - p#otocopies of t#e letter after writing it and sign all copies (7 original and - p#otocopied letters) respecti'el!. And please return t#em sealed in an official en'elope w#ic# is signed  across t#e $ac% to t#e applicant* ot#erwise, t#e! are not 'alid.

 Name8


Title: !osition and Institution8 Address8 Telep+one8 *o9 long +ae #ou ?no9n t+e applicant and in 9+at conte2t

!lease assess t+e applicants qualities in t+e ealuation ta.le gien .elo9 Rate t+e applicant compared to ot+er  indiiduals 9+om #ou are familiar 9it+ 9lassi&cation

%rul"

>cellent

?er" Good

Good

>ceptional  %op 2 Academic Achievement 5uture Academic 7otential ntegrit"

@elo# Average

%op 10

%op 2/

Middle /0

8o#er 2/

+A


0/$ !lease proide us 9it+ comments on t+e applicant@s performance record: potential: or personal qualities 9+ic+ #ou  .eliee 9ould .e +elpful in considering t+e applicant@s application for t+e proposed degree program

-A%(""""mmdd)3

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 [Form 7]

8=>?6서 ("eson*l Medic*l Assessment)  &lease pro'ide accurate information for t#e following uestions.  Note8 Applicants are not required to undergo an aut+orized medical e2am .efore passing t+e $ nd round of  selectionE +o9eer: all candidates must ta?e a compre+ensie medical e2am after t+e $ nd round of selection & see 01 8 'E all grantees must ta?e anot+er compre+ensie medical c+ec?: T7! drug test' after coming into -orea in accordance 9it+ t+e requirements of t+e -orea I mmigration "erice and t+e -)"! If t+e results s+o9 t+at an# grantee is unfit t o stud# and lie oerseas: +e/s+e ma# .e disqualified

1"TION 0

=+en and for 9+at reason did #ou last consult a  p+#sician &!lease e2plain'

1

 *ae #ou +ad an# serious ailment: inBuries or diseases &+ig+ .lood pressure: dia.etes: tu.erculosis: an# t#pe of  *epatitis: *I>: etc' in t+e last fie #ears &If #es: please e2plain'

$

*ae #ou .een +ospitalized in t+e last t9o #ears &If #es: please e2plain'

3

*ae #ou eer .een treated .# a doctor for an# mental: emotional: or an2iet# disorder &If #es: please e2plain and attac+ a report from #our  doctor'

5

*ae #ou eer .een addicted to an# su.stance &If #es: please e2plain'

5

 Do #ou +ae an# allergies &If #es: please list t+em'

H

Do #ou +ae an# isual or +earing impairment



Do #ou +ae an# p+#sical disa.ilities

J

Do #ou +ae an# cognitie/mental disa.ilities

K

Are #ou ta?ing an# prescri.ed medication &If #es: please e2plain'

0L

Are #ou on a special diet &If #es: please e2plain in detail'

Y"

NO

G!%AIN

00

*ae #ou eer suffered from depression &If #es: please e2plain'

T* AN"=R" I *A> )I>N A7O> AR TR1 AND CORRCT TO T* 7"T OF (Y -NO=%D) IF (Y AN"=R" CONTAIN ANY -IND OF FA%"*OOD: I =I%% TA- ANY %)A% R"!ON"I7I%ITY

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[Form 8]

,사 @A => ?6서 (Cetic*te of !e*lth) "#is certificate will $e #ig#l! appreciated in t#e process of selection of orean 6o'ernment c#olars#ip recipients and t#e admissions to a orean uni'ersit!. &lease attac# e'idential documents w#ic# pro'e t#at t#e result of t#e  following examinations is true and correct* ot#erwise, it is not 'alid.

1- Per!onal "nformation Full Name8 "e28 Date of 7irt+8  Nationalit#8

2- P'$!ical %9amination 7lood !ressure8 "#stolic

Diastolic

>ision8 Rig+t $L/ Corrected8 Rig+t

%eft $L/ /0M %eft

Dental aluation8 )ood &

' Fair &

mm*g Color >ision

/0M ' !oor &

' Needs Attention &

'

Clinical aluation8 Classification

Normal

A.normal

Classification

"?in

*eart

*ead , Face

A.domen

Normal

A.normal

#es

Rectum

ars

)enitalia

(out+ , T+roat

2tremities

 Nose , "inuses

7ac? , "pine

 Nec?

Neurological

C+est , %ungs

(ental Ot+er

If A.normal8

6- ,'e!t :0ra$ %9amination Date ta?en8 Findings8

4- #a;orator$ %9amination *emoglo.in8 1rine8 ")

)m/dl "ugar

(icro

*epatitis 78 "tool for !arasite Oal8 "erological Test for "#p+ilis8 Ot+er8 In m# opinion +is/+er +ealt+ condition isE 2cellent & ' )ood & ' Fair & ' !oor & '

T+is is to certif# t+at t+e a.oe named applicant +as gone t+roug+ a general medical e2amination and t+e findings indicated +ere are true and correct to t+e .est of m# ?no9ledge

Date M+D #i%nature

!ospital or nstitute