2009년도 대한민국 정부초청

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1 2018 GLOBAL KOREA SCHOLARSHIP Korean Government Scholarship Program Application Guidelines for Undergraduate Degrees (via Korean Embassies) 1. Objectives The Korean Government Scholarship Program for undergraduate degrees is designed to provide international students with opportunities to study at higher educational institutions in Korea for Bachelor-level degrees, which in turn will contribute to promoting the international exchange in education and to deepening the mutual friendship among countries. 2. Total Number of Scholars to Be Selected: 95 [from 64 countries] Only those who hold citizenship of the countries below are eligible to apply. Reserved Reserved Country Country Country Quota Quota Afghanistan 1 Equatorial Guinea Reserved Quota Country Reserved Quota 1 Mexico 4 Singapore 1 Angola 1 Ethiopia 3 Mongolia 3 Sri Lanka 1 Azerbaijan 1 Gabon 1 Mozambique 1 Sweden 2 Bangladesh 1 Ghana 1 Myanmar 1 Tajikistan 1 Bolivia 1 Guatemala 1 Nepal 1 Tanzania 1 Brazil 4 India 2 Nigeria 1 Thailand 2 Bulgaria 1 Indonesia 3 Pakistan 1 Timor-Este 2 Bhutan 1 Iran 2 Panama 1 Trinidad and Tobago Cambodia 1 Iraq 1 Paraguay 1 Turkey 1 Chile 1 Japan 2 Peru 1 Turkmenistan 2 Colombia 3 Jordan 1 Philippines 1 Uganda 2 Congo(DRC) 1 Kazakhstan 2 Poland 1 Ukraine 2 Dominican Republic 1 Kenya 3 Russia 2 Uruguay 1 Ecuador 1 Kyrgyzstan 2 Rwanda 1 Uzbekistan 2 Egypt 1 Laos 1 Senegal 1 Venezuela 1 El Salvador 1 Malaysia 1 Sudan 1 Vietnam 3 One placement is reserved for overseas Koreans within each of the highlighted country s scholarship quota. (e.g., For Brazil, 1 placement is reserved for those of overseas Koreans, and 3 placements are available to general applicants.) 1 1

2 3. Academic Programs: Bachelor s Degree Program (4 years) after preliminary Korean Language Program (1 year) Scholars must take the mandatory Korean language training at a language institution that will be designated by NIIED. The institution will be specified in the letter of invitation after the announcement of final successful candidates. Scholars must attain a certain level on TOPIK (Test of Proficiency in Korean) as required by NIIED before the completion of the one-year Korean language program. Otherwise, scholars are not allowed to proceed to the degree program. Scholars with level 5 or 6 on TOPIK will be exempt from the language program and must begin their Bachelor s degree program from Spring 2018 Scholars who receive TOPIK level 5 or 6 during the first 6 months of the language program may start their degree program in the Fall 2018 semester. 4. Available Universities and Fields of Study : 4-Year Bachelor s degree programs offered at the universities below. Chonbuk National University Chonnam National University Chosun University Hallym University Korea University Silla University Handong Global University KOREATECH Sogang University Hankuk University of Foreign Studies Kumoh National Institute of Technology Sookmyung Women s University Chung-Ang University Hannam University Kyunghee University Soonchunhyang University Chungbuk National University Chungnam National University Hanyang University Kyungpook National University Soongsil University Hoseo University Kyungsung University Sun Moon University Daegu University Inha University Myongji University Sungkyunkwan University Dankook University Jeju National University Namseoul University University of Seoul Dong-A University Jeonju University Pai Chai University University of Ulsan Dongguk University (Gyeongju Campus) Dongguk University (Seoul Campus) KAIST Pukyong National University UNIST Keimyung University Pusan National University Wonkwang University Dongseo University Kongju National University Sangmyung University Yeungnam University Ewha Womans University Konkuk University Semyung University Yonsei University Gachon University Gyeongsang National University Konyang University Kookmin University Seoul National University of Science and Technology Seoul National University <58 universities> Attention! Any degree program which takes more than 4 years to complete is NOT AVAILABLE under this scholarship program. All applicants cannot choose such degree programs (Examples: medicine, dentistry, architecture, and pharmacy) For more details on the available fields and majors, refer to the University Information file that is available to access in the GKS Notice board, on the Study in Korea website ( All applicants must choose a major listed on the University Information. 2

3 5. Qualifications: Prospective applicants must meet all of the following conditions. (1) CITIZENSHIP: An applicant and his or her parents must be citizens of one the countries listed on the above chart in #2 of this guideline. Attention! Neither the applicant nor the parents should hold the Korean citizenship. Exception(Only for those holding Japanese Citizenship): Individuals whose parents hold a Special Permanent Residency Permit within Japan while holding Korean Citizenship may be deemed eligible to apply. (2) AGE: An applicant must be under age 25 as of March 1, 2018 (Should be born after March, 1, 1993). (3) HEALTH: An applicant must be in good health, both physically and mentally. Those with disabilities, but in good mental and physical health, are eligible to apply. Those with severe illness are NOT ELIGIBLE to apply. (4) LEVEL OF EDUCATION: An applicant must have graduated or be expected to graduate from a high school as of March 1, 2018 Those who have already achieved a Bachelor s degree or a higher degree are NOT ELIGIBLE to apply. Those who have graduated or are expected to graduate from a high school in Korea are NOT ELIGIBLE to apply. (5) GRADES: An applicant must either have the cumulative grade point average (C.G.P.A.) of 80% (out of 100%), or be ranked within the top 20% throughout the entire high school period. C.G.P.A. should be 2.64/4.0, 2.80/4.3, 2.91/4.5, 3.23/5.0 or higher [see Appendix 3] If an applicant s high school has an evaluation system different from the above scales, see 7-(2)-9. (6) An applicant should never have been awarded with any scholarship programs from Korea for an undergraduate degree program. (7) An applicant must have no limitations in travelling abroad (8) Applicants who have proficiency in the Korean or English language will be given preference. (9) Descendants of the Korean War veterans will be given preference. (10) Engineering and Science majors will be given preference. (11) Applicants from low income families or underprivileged backgrounds will be given preference. (12) Applicants who are confirmed to be third generation overseas Koreans will be given preference. (13) An applicant is restricted to apply either for the Embassy Track or for the Regional University Track. Applicants who apply for both tracks will be automatically disqualified and their applications will be eliminated. 3

4 6. Scholarship Benefits (1) Scholarship Period: March 1, 2018 ~ February 28, 2023 (1-year Language + 4-year Degree Program) (2) Scholarship Benefits 1 Airplane Ticket or Airfare: The scholarship covers an economy class flight with the shortest route between a scholar s country and Korea. A one-way ticket to Korea will be offered to each scholar at the beginning of the scholarship program; another one-way ticket from Korea will be offered for those who complete their studies under the scholarship program. 2 Monthly Stipend: 800,000 KRW per month 3 Tuition: The tuition fee up to 5 million KRW is covered by NIIED. In case the tuition is higher than 5 million KRW, the exceeding amount is covered by the host university. The university entrance fee is covered by the host university. 4 Settlement Allowance: 200,000 KRW upon arrival 5 Scholarship Completion Grants: 100,000 KRW upon completion of studies 6 Korean Language Training: The full cost for the 1 year is covered by NIIED and the language institution. 7 Medical Insurance: Scholars are covered by health insurance for major accidents and illnesses during their scholarship period. 8 Korean Proficiency Grants: Scholars with level 5 or 6 on TOPIK will receive 100,000 KRW won per month during the degree program. (3) Notes 1 NIIED does not cover the expenses for the domestic travel both in a scholar s home country and in Korea. 2 Airfare for entry into Korea will not be provided to a grantee that has been staying in Korea as of the date of announcement of successful candidates 3 NIIED does not cover the expenses for traveler s insurance. 4 The medical fee is to be reimbursed through the insurance company to a scholar after he or she pays first. However, the expense for dental care or chronic disease will not be covered. 5 In case a scholar withdraws from the scholarship program within the first 3 months after entering Korea, he or she must return all the scholarship benefits offered, which includes the entry airfare, settlement allowance, monthly stipend, tuition, language training fees, Korean proficiency grants, and medical insurance. 6 The return flight ticket and the Scholarship Completion Grants will not be offered for those who withdraw from the scholarship program. 7 If a student temporarily leaves Korea during the language program, the allowance will not be given during the period student was absent in Korea. The allowance will not be given if a student s leave of absence period exceeds 30days during the degree program. 7. Required Documents (1) Required Documents: 1 set of the original documents below, and 3 sets of the photocopies of the original 1 Completed Application Form (Form 1) 2 NIIED Pledge (Form 2) 3 Personal Statement (Form 3) 4 Study Plan (Form 4) 5 Two Recommendation Letters (Form 5) Must be from two separate recommenders. The letters must be written by someone who can give in-depth assessment on the applicant s abilities, including a high school teacher, principal, or academic advisor. 6 Completed Self Medical Assessment (Form 6) 4

5 7 Graduation Certificate of High School Those who are expected to graduate may submit a provisional graduation certificate of high school. 8 High School Grade Transcript (including a description of the school s grading system) 9 Certificates of Citizenship of the Applicant and Parents (Examples: a birth certificate, a governmentissued certificate indicating the parent-child relationship, a family register, or parents passport copies) 10 Awards (Optional) 11 Applicants with certified scores on their proficiency in Korean or in English may be given preference. Some examples include the following: Proficiency in Korea: TOPIK (Test of Proficiency in Korean) Proficiency in English: TOEFL, TOEIC, or IELTS Academic (TOEFL ITPs are not acceptable) 12 Certificate of Health (Form 7, only for candidates who successfully pass the 2 nd round of selection) The certificate of health must be completed and signed by a doctor. 13 Copy of the Applicant s Passport (only for candidates who successfully pass the 2 nd round of selection) 14 Overseas Korean Proof Documents and supporting documents indicating the generation status (applicable to Overseas Koreans Only) (2) NOTES 1 The total 4 set of application documents (1 set of the original & 3 sets of the photocopies) should be placed in separate envelopes. The original set must be marked as Original on its envelope. Recommendation letters should be sealed by the recommenders and submitted with the seals unbroken. 2 Original documents should be submitted. However, if copies are submitted, copies must be authenticated by the issuing institution, confirming that they are the same with the originals. 3 The applicant s name on the application form MUST be identical to the applicant s passport name. 4 If there is any inconsistency in the applicant s name or birth date on submitted documents, further evidential document must be submitted as verification. 5 Any applicant, who submits a provisional graduation certificate at the time of applying, must submit his or her official graduation certificate of high school upon arrival in Korea, no later than March 1, The application documents must be arranged in the same order as written on the Checklist in the FORM 1. Each document may be stapled. However, DO NOT staple the entire application documents altogether, or put each document in a separate folder. 7 Application form and all other materials should be filled out either in Korean or in English. Any document issued in languages other than Korean or English MUST include official notarized translations. 8 All documents submitted must be A4 sized. If the document is smaller, attach it to A4 sized paper; if bigger, fold it to make it A4 sized. 9 The high school grade transcript must contain a description of the school s grading system. In case the transcript does not have information on the applicant s rank or percentile score, an applicant must submit an additional official certificate issued by the high school, confirming that the applicant s academic achievement meets the requirement written on 5-(5) above. 10 All documents must be numbered and labeled on the top right corner. (Example. 7 Graduation Certificate of High School) 11 Mailing address should be stated in full including the postal-code. 12 Submitted documents will not be returned to the applicant. The applicants are advised to make their own copies of all application documents. 13 Incomplete or incorrect documents will result in the disqualification of an applicant. 8. Application Deadline: To be decided by the Korean Embassies [see Appendix 1] For details on the application deadline and the submission of application documents, applicants should contact the Korean Embassy, the Korean Education Center, or the Korean Cultural Center in their home countries, or in the neighboring countries if there is no Korean diplomatic missions in one s home country. The first round of selection will be conducted by the Korean Embassy. All applications submitted to NIIED by individual applicants or by the foreign embassies in Korea will NOT BE ACCEPTED and will be discarded. 5

6 9. Selection Procedures Period September, 2017 Details [1 st ROUND] Each Korean Embassy (KE) announces call for applications. Applicants must check the announcement from KE, including the deadline. September ~ October November 3 November 17 December 6 November 27 ~ December 28 January 5, 2018 Early February Late February KE conducts the first round of selection. Applicants submit the application documents to KEs in respective countries. KEs will conduct the interviews on applicants. KEs forward the application documents of selected candidates to NIIED. [2 ND ROUND] NIIED conducts the second round of selection through a selection committee. NIIED announces the result of the second round of selection on the GKS Notice board on Candidates who pass the second round must submit the passport copy and the certificate of health (FORM 8) to KE by December 6, [3 rd ROUND] NIIED forwards the application documents of the successful candidates to the universities by November 24, Each university conducts the final round of review for admission, and notifies individual candidates of the admission results by December 22, Candidates must choose ONE university and notify NIIED of their final choice by December 28, NIIED announces the final successful candidates on the GKS Notice board on KE informs the scholars of their scheduled entry to Korea. Scholars must check their entry flight itinerary and make preparations to enter Korea. Entry to Korea NOTES Applicants must follow the NIIED s regulations throughout the application procedure. Applicants must choose up to 3 different universities and write their choice in the Forms 1, 4, and 5. Applicants must choose only ONE department (or major) for each university, as listed on the University Information. In choosing the preferred universities and majors, it is advisable to contact the universities in advance for further information. (See Appendix 2 for the university contact information.) After the announcement of the 2 nd round result, NIIED will forward the candidates documents to the universities as written on the application forms. All applicants must double-check their choice of preferred universities on the application form in order to ensure that their application documents are reviewed by RIGHT and CORRECT universities. 6

7 Additional documents might be required to be submitted depending on the university or department, especially for majors in the field of fine arts, music or physical education. If asked so, the applicants must submit the requested documents to the university. Attention! A candidate who fails to receive admission to any one of the three universities will NOT BE SELECTED as a KGSP scholar. Transferring to a different university is NOT allowed after the confirmation of an applicant s final choice of a university. Regardless of university admission, all scholars must achieve the TOPIK level required by NIIED before the completion of the 1-year Korean language program. Any scholar who fails to do so cannot proceed to his or her degree program. 10. Other Important Information (1) Entry 1 Scholars must arrive in Korea by late February, In case a scholar does not enter Korea by the designated date, his or her scholarship will be canceled. 2 Prior to the arrival, all scholars are advised to study about Korea, Korean language and culture. In particular, it is advisable that grantees learn as much Korean as possible because most classes at a Korean university are taught in Korean. Scholars should check with their universities in advance which language is the medium of communication in the program. Below are some websites that scholars will find useful in preparing their studies in Korea. Korean Language Study Korean Universities Korean Culture The Korean Embassy abroad Entry & Residence ( 세종학당->KOSNET 배우기 ) (2) Housing 1 Scholars will live in a university dormitory. 2 The dormitory fee will be deducted out of the monthly stipend by the university. (3) Cancellation and Temporary Suspension of Scholarship 1 Cancellation of Scholarship: If a scholar is found engaged in any of the following activities during his or her stay in Korea, the scholarship will be suspended and then canceled. When any documents of the scholarship application has been found false; When a scholar violates the NIIED regulations s/he has pledged to keep; When a scholar fails to abide by the academic guidelines and regulations set by NIIED; When a scholar receives disciplinary punishment from the university. When a scholar acts in a way that harms the reputation of the scholarship and/or the relevant institutions; 7

8 When a scholar fails to reach a TOPIK level required by NIIED within the period of one year language program; When a scholar earns less than 2/3 of the registered credits of a semester; When a scholar leaves Korea for the purpose of joining an exchange program in another country; When a scholar fails to notify NIIED of re-enrollment without any proper reasons after the end of a leave of absence; When a scholar receives three warnings or more; When a scholar forfeits the scholarship. 2 Temporary Suspension of Scholarship During the Korean language program, scholars may leave Korea under the language institution s approval for up to 2 weeks during the semester and for up to 4 weeks during vacation. For the days of staying outside of Korea, the monthly allowance will not be given. During the Associate degree program, scholars may leave Korea for up to 60 days at a time, under the university s approval. For the days exceeding 30 days, the monthly allowance will not be given. 11. Contact (1) Application & Document Submission: Korean Diplomatic Missions (See Appendix 1) (2) Major & University Admissions: 59 Korean Universities (See Appendix 2) (3) Other Inquiries: NIIED Website: (Scholarships > Government Scholarship > GKS Notice) kgspniied@korea.kr 8

9 2018 년 GLOBAL KOREA SCHOLARSHIP 대한민국정부초청외국인학부장학생모집요강 ( 공관추천용 ) 1. 목적외국인학생에게대한민국고등교육기관에서수학할기회를부여함으로써국제교육교류촉진및국가간우호증진을도모하고자함 2. 초청인원 : 64 개국 95 명 ( 아래국가의국적을소지한자만프로그램에지원할수있음 ) 국가명 인원 국가명 인원 국가명 인원 국가명 인원 가나 1 베네수엘라 1 엘살바도르 1 케냐 3 가봉 1 베트남 3 요르단 1 콜롬비아 3 과테말라 1 볼리비아 1 우간다 2 콩고 (DRC) 1 나이지리아 1 부탄 1 우루과이 1 키르기스스탄 2 네팔 1 불가리아 1 우즈베키스탄 2 타지키스탄 1 도미니카 ( 공 ) 1 브라질 4 우크라이나 2 탄자니아 1 동티모르 2 세네갈 1 이라크 1 태국 2 라오스 1 수단 1 이란 2 터키 1 러시아 2 스리랑카 1 이집트 1 투르크메니스탄 2 르완다 1 스웨덴 2 인도 2 트리니다드토바고 1 말레이시아 1 싱가포르 1 인도네시아 3 파나마 1 멕시코 4 아제르바이잔 1 일본 2 파라과이 1 모잠비크 1 아프가니스탄 1 적도기니 1 파키스탄 1 몽골 3 앙골라 1 칠레 1 페루 1 미얀마 1 에콰도르 1 카자흐스탄 2 폴란드 1 방글라데시 1 에티오피아 3 캄보디아 1 필리핀 1 음영표시된 10 개국배정인원은재외동포배정인원 ( 국가별 1 명 ) 을포함한인원임 3. 모집과정 : 1 년이내한국어연수후 4 년제학사과정 한국어연수기관은국립국제교육원이지정함 ( 최종합격자발표후초청장에기재 ) 1 년한국어연수종료후일정의 TOPIK 급수취득학위과정으로진학 TOPIK 5 급이상을소지한자는한국어연수없이 2018 년 3 월부터학위과정진학 한국입국후 6 개월내 TOPIK 5 급이상을취득한자는 2018 년 9 월조기진학 4. 지원가능대학및진학가능학과 : 아래 58 개대학내개설된 4 년제학과 수학연한이 4 년을초과하는학과 ( 의학, 치의학, 건축학과, 약학과등 ) 는제외 자세한정보는 GKS 웹사이트 ( 의 University Information 참조. 지원자는반드시 University Information 에등재된대학과그대학에개설된학과만지원해야함 9

10 < 지원가능대학 > 가천대 고려대 동국대 ( 경주 ) 서강대 순천향대 이화여대 충남대 한양대 건국대 공주대 동서대 서울과학기술대 숭실대 인하대 충북대 호서대 건양대 국민대 동아대 서울대 신라대 전남대 한국과학기술원 경북대 금오공대 명지대 서울시립대 연세대 전북대 한국기술교육대 경상대남서울대배재대선문대영남대전주대한국외대 경성대단국대부경대성균관대울산과학기술원제주대한남대 < 총 58 개교 > 경희대대구대부산대세명대울산대조선대한동대 계명대동국대상명대숙명여대원광대중앙대한림대 5. 지원자격 (1) 추천대상국국적소유자 ( 본인및부모 ) 본인및부모모두한국국적을소유하지않은자이어야함 (2) 2018 년 3 월 1 일현재, 만 25 세미만인자 (1993 년 3 월 1 일이후출생한자 ) (3) 한국에서의장기간유학이가능할정도로신체적으로정신적으로건강한자 위 (3) 항을충족하는장애인도지원할수있음 질병치료중인자는지원할수없음 (4) 2018 년 3 월 1 일현재고등학교졸업자 한국내고등학교졸업자및학사학위이상소지자는지원할수없음 (5) 고등학교전학년누계평점평균 (C.G.P.A.) 이 80% 이상이거나성적상위 20% 이내인자 C.G.P.A. 가 2.64/4.0, 2.80/4.3, 2.91/4.5, 3.23/5.0 이상이어야함 [Appendix 3 참조 ] 만약지원자의고등학교성적기재방식이위와다른경우, 7-(2)-9 참조 (6) 한국에서동일과정의장학금을받은사실이없는자 (7) 해외여행에결격사유가없는자 (8) 한국어또는영어능력우수자우대 (9) 한국전쟁참전용사후손특별우대 (10) 이공계전공우수인재특별우대 (11) 가정형편등사회, 경제적배려대상자우대 (12) 재외동포지원자중에서도 3 세대이후 (3 세대포함 ) 재외동포우대 (13) 지원자는공관또는지방대이공계전형중하나만지원가능 공관과지방대이공계전형에중복지원하면 2 차전형심사대상에서제외 6. 장학금지급 (1) 지급기간 : ~ ( 한국어연수기간 1년, 학위과정 4년 ) (2) 지급내역 1 항공권또는항공료 : 최초입국시및최종귀국시서울과당해국최단거리국제공항간일반석항공권또는항공료지급 2 생활비 : 매월 800,000원 3 학비 : 전학기등록금은국립국제교육원에서, 입학금은대학에서지원 4 정착지원금 : 최초입국시 200,000원 5 귀국준비금 : 최종귀국시 100,000원 6 어학연수비 : 본원이지정한교육기관에직접지급 7 의료보험 : 장학기간중질병, 상해, 사고등에대한보험료 8 한국어능력우수자 (TOPIK 5급이상취득자 ) 에게는학위과정진학후월 100,000원지급 10

11 (3) 유의사항 1 장학생의자국내이동및한국내이동항공료는지원하지않음 2 장학생확정선발통보일기준한국에체류중인자는입국항공료를지급하지않음 3 입국및귀국여행에따른보험료는지원하지않음 4 의료비는장학생이병원또는약국에선납후보험사를통해 5 중도포기자에게는귀국항공료와귀국준비금을지원하지않음 6 한국입국후 3 개월이내중도포기한경우, 장학금전액 ( 입국항공료, 정착지원금, 생활비, 한국어연수비등 ) 을반납하여야함 7 한국어연수기간중일시출국기간의생활비, 학위과정중학기당 30 일초과일시출국기간의생활비는지원하지않음 7. 제출서류 : 아래서류원본 1부및사본 3부 (1) 제출서류 1 지원서 1부 (Form 1) 2 서약서 (Form 2) 3 자기소개서 (Form 3) 4 수학계획서 (Form 4) 5 추천서 2부 [Form 5, 추천인 ( 지도교사, 출신학교장, 지도교수등 ) 2명으로부터각 1부 ] 6 자기건강진단서 (Form 6) 7 고등학교졸업증명서 1부또는고등학교졸업예정증명서 1부 ( 현재고등학교졸업자에한함 ) 8 고등학교성적증명서 1부 ( 학교의성적시스템에대한설명서포함 ) 9 본인및부모의외국국적을확인할수있는증명서 ( 출생증명서또는가족관계증명서, 부모여권사본등 ) 10 수상실적등 ( 해당자에한함 ) 11 한국어또는영어공인성적증명서 ( 소지자에한함, 한국어-TOPIK / 영어-TOEIC, TOFLE, IELTS Academic * 기관 TOFLE 등효력이제한적인어학능력시험은인정되지않음 ) 12 의사가발급한영문건강증명서 (Form 7, 2차선발전형통과자에한함 ) 13 본인여권사본 (2차선발전형통과자에한함 ) 14 재외동포입증서류및세대입증서류 ( 해당자에한함 ) (2) 유의사항 1 서류원본과사본 3부는각각별도의봉투에넣어제출하도록함 : 추천서는개봉하지말고 추천자가밀봉해준대로제출하여야함 2 모든 서류는 원본이어야 함. 만약 원본을 제출할 수 없는 경우, 당초 서류 발급 기관으로부터원본과같다는확인을받은복사본을제출할수있음 3 지원서의영어성명의철자는반드시여권의것과같아야함 4 지원서류에기재된지원자의성명이나생년월일등이일치하지않을경우, 이를증빙하는 추가서류를제출하여야함 5 고등학교졸업예정자로지원당시고등학교졸업예정증명서를제출한자는한국도착후 즉시고등학교졸업증명서를제출하여야함 6 지원서류는 FORM 1의체크리스트순으로제출하여야하며, 서류 1종을스테이플로철할수 있으나, 서류전체를스테이플로철하거나투명파일에하나씩끼워제출하지않도록함 7 신청서를비롯한모든서류는한국어또는영어로작성해야하며, 한국어또는영어로작성되지않은서류에는반드시공증번역본을첨부하여야함 ; 공증본은원본앞에정렬함 8 모든서류는 A4 규격으로제출하여야함. 만일서류가 A4보다작을경우별도 A4 용지에 부착하여제출, A4보다클경우 A4 규격에맞도록접어서제출하여야함 9 성적증명서에는성적시스템에대한설명서가반드시포함되어야하며, 만약성적증명서에 지원자의석차나비율이표시되어있지않은경우, 지원자의성적이지원자격 ( 상기 5항-(5)) 을 충족한다는확인서 ( 고등학교에서발급 ) 를추가제출하여야함 10 본원소정양식이외의서류는상단우측에서류명을적어야함 11

12 ( 예 ) 7 Graduation Certificate of High School 주소는우편번호를포함한전체주소를적어야함제출한서류는반환하지않음. 지원자는모든지원서류의복사본을만들어보관하기바람제출서류의기재내용이부정확하거나미비서류가있는경우에는선발대상에서제외함 8. 지원기한 : 한국대사관에서정함 [Appendix 1 참조 ] (1) 프로그램지원및지원서제출등에관한사항은출신국주재 ( 또는관할 ) 한국대사관 ( 또는한국교육원, 문화원 ) 에문의하여야함 (2) 1 차선발전형을담당하는한국대사관을통하지않은지원서는접수하지아니함 : 지원자가 NIIED 에직접지원하거나주한외국대사관을통하여지원할수없음 9. 선발절차 일정 ~ 월초 월초 ~ 월말 선발절차각주재국한국대사관 ( 이하 KE) 은 KE 장학생후보선발계획발표 지원자는 KE 장학생후보선발계획확인 [1 차선발전형 ] KE 장학생후보선발 지원자는 KE 의장학생후보선발계획에따라원서제출및면접응시 1 차선발전형통과자는 KE 의지시에따라지원서 (NIIED 소정양식 ) 를온라인으로제출 ~ KE 는 1 차선발전형통과자를본원에추천 ~ [2차선발전형] NIIED 장학생선정위원회개최, NIIED 2차선발전형결과발표 ( (NOTICE) 2차선발전형통과자는여권사본, 의사발급건강증명서를 까지 KE에제출 (KE는동서류를 NIIED에송부 ) [3차선발전형] 대학입학전형 - NIIED는 2차선발전형통과자의대학입학전형서류를대학에송부 : 대학별입학전형실시 ( 서류심사및면접등 ), 합격자발표 : ~ 차선발전형통과자는최종진학대학결정및 NIIED에통보 : NIIED 최종합격자발표 월 ~2 월 ~2.20 한국입국 KE 는최종합격자에게입국일정통보 최종합격자는입국일정확인및입국준비 (1) 유의사항 ( 대학입학전형관련 ) 1 지원자는대학입학전형과관련해서국립국제교육원에서정한방침에따라야함 2 FORM 1 및 FORM 4, FORM 5 에진학희망대학및전공을 3 지망까지기재하여야함. 희망전공은진학희망대학별 1 개를선택하여야함 [2018 KGSP-U University information 참조 ] 3 진학희망대학및전공을선택하기전에, 해당대학에연락을취하여관련사항을확인하기바람 [Appendix 2 참조 ] 4 2 차선발전형결과발표후본원은지원서에기재한진학희망대학및전공에의거하여대학입학전형서류를대학에송부하므로, 지원서작성시대학및전공을신중하게선택하여기재하여야함 5 대학입학전형시, 특정대학또는학과의방침상추가서류를제출하여야하는경우해당자는대학의요청에따라추가서류를제출하여야함. 6 지원한대학중어느대학으로부터도입학허가를받지못할경우, 장학생선발대상자에서제외되므로신중하게대학을선택하기바람 7 최종진학대학을결정한후대학을변경할수없음 8 대학에입학허가를받았어도한국어연수종료후일정 TOPIK 급수를취득하지못하면학위과정에진학할수없음 12

13 10. 기타유의사항 (1) 입국 1 선발된장학생은 월말까지입국하여야함. 지정된기일내에입국하지않을경우장학생자격이취소됨 2 장학생은입국전에한국및한국문화등의사전연구가필요함. 특히대부분대학의수업이한국어로진행되므로한국어를사전학습하여주시기바람. 또한일부강좌의경우영어를사용할수있으므로장학생은이를확인하고, 필요한경우영어능력향상을위해노력해주기바람 한국어학습 ( 세종학당 ->KOSNET 배우기 ) 한국내대학 한국문화이해 재외한국공관 입국및체류 (2) 숙소 1 장학생은한국어연수및학사과정수학대학의기숙사에서생활하게됨 2 기숙사비는본원에서지원하는생활비에서공제함 (2) 장학금지급중단및일시정지 1 다음의경우에는장학생자격을상실하고장학금지급을중단함 - 지원서류가허위로작성되었거나사실과다른것으로드러났을때 - 국립국제교육원에서약한사항을위반했을때 - 국립국제교육원이정한학사행정조치사항에따르지아니한때 - 수학기관으로부터징계처분을받은때 - 장학생으로서품위를손상시키는행동을한때 - 한국어연수후일정 TOPIK 급수에도달하지못한때 - 무단수학중단으로학위과정재학중해당학기에수강신청한과목학점의 2/3 이상을 취득하지못한때 - 외국대학과의학점교류등으로출신국또는제3국으로출국한때 - 휴학기간종료후정당한사유없이복학하지않은경우 - 경고 3회이상받은때 - 중도포기했을때 2 다음의경우에는장학금지급을일시정지함 - 한국어연수기간중에장학생은소속한국어연수기관의허가를받아학기중에는최대 2주, 방학중에는방학기간범위내최대 4주일시출국할수있음. 그러나일시출국 기간의생활비는지급하지아니함 - 학위과정중에장학생은소속대학의허가를받아 1회 60일을출국할수있음. 그러나 방학을 포함하여 학기당 30일을 초과하여 일시 출국하는 경우, 30일 초과 기간의 생활비는지급하지아니함 11. 문의처 (1) 프로그램지원및지원서제출 : 출신국주재 ( 또는관할 ) 한국대사관 ( 또는한국교육원 ) [Appendix 1 참조 ] (2) 대학입학 : 58 개한국대학 [Appendix 2 참조 ] (3) 기타 - ( 국립국제교육원 Website: [English version : Global Korea Scholarship NOTICE] - 이메일상담 : kgspniied@korea.kr 13

14 [Appendix 1 - Contact Points - Application for the Program] Korean Embassies Applicants from the countries marked with * should apply for the program through the APPROPRIATE Korean Embassy (or Korean Education Center). (see Remarks) No. Country TEL FAX 1 Afghanistan kabul@mofa.go.kr 2 Angola ~ Korembassy_angola@mofa.go.kr 3 Azerbaijan ~ azeremb@mofa.go.kr 4 Bangladesh ~ embdhaka@mofa.go.kr 5 Bolivia ~ coreabolivia@gmail.com 6 Brazil emb-br@mofa.go.kr 7 Bulgaria / Korean-embassy@mofa.go.kr 8 Bhutan* ~ embdhaka@mofa.go.kr 9 Cambodia ~ cambodia@mofa.go.kr 10 Chile embajadadecoreaenchile@gmail.com 11 Colombia embacorea@mofa.go.kr 12 Congo (DRC) ~4 amb-congo@mofa.go.kr 13 Dominican Republic embcod@mofa.go.kr 14 Ecuador ~ ecuador@mofa.go.kr 15 Egypt ~ egypt@mofa.go.kr 16 El Salvador embcorea@mofa.go.kr 17 Equatorial Guinea Malabo@mofa.go.kr 18 Ethiopia /111~ ethiopia@mofa.go.kr 19 Gabon gabon-ambcoree@mofa.go.kr 20 Ghana / ghana@mofa.go.kr 21 Guatemala ~ ~8 embcor.gt@mofa.go.kr 22 India india@mofa.go.kr 23 Indonesia koremb_in@mofa.go.kr 24 Iran ~ emb-ir@mofa.go.kr 25 Iraq kembiraq@mofa.go.kr 26 Japan ~ General_jp@mofa.go.kr 27 Jordan Jordan@mofa.go.kr 28 Kazakhstan Korean Education Center in Almaty 29 Kenya emb-ke@mofa.go.kr 30 Kyrgyzstan Korean Education Center in Bishkek 31 Lao PDR ~ laos@mofa.go.kr 14

15 32 Malaysia Mexico Mongolia Mozambique Myanmar ~ Nepal Nigeria Pakistan ~ Panama Paraguay Peru Philippines Poland Russia / Rwanda Senegal / Singapore Sudan Sri Lanka ~ Sweden Tajikistan Tanzania Thailand ~ Timor-Este / Trinidad and Tobago Turkey ~ Turkmenistan ~ Uganda / Ukraine ~ Uruguay ~ Uzbekistan ~ Venezuela Vietnam

16 [Appendix 2 - Contact Points - Application for University Admission] * Country code: 82- Korean Universities NO University Person in Charge Tel Fax address 1 Chonbuk National University Ms. Hyeseon Choi kgsp@chonbuk.ac.kr 2 Chonnam National University Eunhui CHA gradia@jnu.ac.kr 3 Chosun University JEONG NA RA lovelyj6167@chosun.ac.kr KANG GI HEE gkang@chosun.ac.kr 4 Chung-Ang University Yong-Hwa Jang foreignstudent@cau.ac.kr 5 Chungbuk National University Minha Kim minhakim@cbnu.ac.kr 6 Chungnam National University Kwak Yujin open_foreign@cnu.ac.kr 7 Daegu University Kim, Hyun hk0128@daegu.ac.kr 8 Dankook University Lee, Byoungmin solinter@dankook.ac.kr Kim, Sunho skim5385@dankook.ac.kr 9 Dong-A University Brian Kay bk1016@dau.ac.kr 10 Dongguk University Yeonsu Jang kgsp@dongguk.edu 11 Dongguk University (Gyeongju Campus) Lee, Sang-Yun boby799@dongguk.ac.kr 12 Dongseo University Lee Yoonseo ysleee@dongseo.ac.kr 13 Ewha Womans University ( HYEWON CHOI hwchoi1102@ewha.ac.kr 14 Gachon University EO, JaeHa jaeha@gachon.ac.kr 15 Gyeongsang National University Mr. Jun Hyeon JO passfi@gnu.ac.kr 16 Hallym University Song Mingeun colorfic@hallym.ac.kr 17 Handong Global University Esther KIM eskim@handong.edu 18 Hankuk University of Foreign Studies Hye young Lee hylee@hufs.ac.kr 19 Hannam University Jung Hyunkung hnujpn@hnu.kr 20 Hanyang University JungIn Choi cjchoi@hanyang.ac.kr Claire Eom isonglee32@hanyang.ac.kr 21 HOSEO University Young Hwan Cho yh.cho@hoseo.edu 22 INHA University Soo Hwan, MUN overowen@inha.ac.kr 23 Jeju National University Lee Junghyo intl2@jejunu.ac.kr 24 Jeonju University ( Jeonju University ( Mr. Hyuk-joo Lee holylove@jj.ac.kr Mr. Jong-Sung Park jspark@jj.ac.kr 16

17 25 Jeonju University ( Jeonju University ( KAIST ( Mr. Jae-hyun Kim Mr. Chung Kwon Lee Eung Song Ko Keimyung University Jinmyoung Kim(Mr.) Kongju National University ( ( Konkuk University ( Lee, Inhaeng Park, Jinyeo Han, Min Young Konyang University Kim Ho-seon Kookmin University Shin, Hye-in Korea University Julie Yoo KOREATECH Selina Lee Kumoh National Institute Of Technology Kyung Hee University (Seoul Campus) Kyung Hee University (Global Campus) Kyungpook National University ( Hyejin Kim Mi-Youn HAN Seonghwan, JI ~ Kyungsung University Sarah Cho Myongji University ( Kang, So Young NAMSEOUL UNIVERSITY Seomoon Chan Nari Kim ~ Pai Chai University ( Pyung-rak Choi Ryan Jongseok Park PUKYONG NATIONAL UNIVERSITY Jungeun Kim Pusan National University Hui-jeong YOON Sangmyung University (Seoul Campus) Kyongrak Park Semyung University Shim Yujin Seoul National University of Science and Technology Youngsung Kim Seoul National University LEE, SoYoun Silla University Mr. Yun, Inseog Sogang University ( Tony(Jae Hyung) Kim Sookmyung Women's University Alice Kang

18 49 SOONCHUNHYNAG UNIVERSITY LIM, JAESAM Soongsil University Jongwon Ahn Jaewhi Han Sunmoon University ( Kyung Min, Lee Sungkyunkwan University Youngran Park University of Seoul Juyeon Kim /6663, University of Ulsan Sean Park Ulsan National Institute of Science and Technology Oh, Youngcheol Wonkwang University LEE HYUN SOO Yeungnam Univesity Lee, Sunho Yonsei Unviersity Jung, Dae Shik

19 [Appendix 3] C.G.P.A. Conversion Table 4.0 Scale 4.3 Scale 4.5 Scale 5.0 Scale 100 Points Scale 3.97 ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~

20 [Form 1] 2018 대한민국정부초청외국인학부장학생지원서 (Application for 2018 KGSP for an Undergraduate Degree) 공관전형 / via Korean Embassies Please type or print clearly in 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. January 30, /01/30) Choose up to 3 preferred universities and departments (or majors) respectively : a department (or major) only for a preferred university 지원자명 (Applicant s name) 국적 (Nationality) 성 (Family name) / 이름 (Given name) / Middle name 생년월일 (Birth-date) (yyyy/mm/dd) 추천유형 (Type of Application) 일반추천 (General) 재외동포추천 (Overseas Korean) 희망계열 (Desired Field of study) 언어능력 (Language Proficiency) 인문사회 (Humanities & Social Sciences) 자연공학 (Natural Sciences & Engineering) 예체능 (Arts and Physical Education) 한국어 (Korean Proficiency) 영어 (English Proficiency) Advanced Intermediate Beginner Advanced Intermediate Beginner 수학희망대학 (Preferred Univ.) 희망전공 (Preferred Dept.) Checklist (Submission of Documents) Please put a in the appropriate box, Type or Print clearly Required Documents 20 Original Document Official Notarized Translation 3 Copied Documents Yes No Yes No Yes No 1 지원서 One Complete Application Form N/A 2 서약서 One NIIED Pledge N/A 3 자기소개서 One Personal Statement N/A 4 수학계획서 One Study Plan N/A 5 추천서 2 부 2 Recommendation Letters (from 2 different recommenders) N/A 6 자가건강진단서 One Self Medical Assessment N/A 7 고등학교졸업증명서 One Graduation Certificate of High school 고등학교성적증명서 One High school Grade Transcripts 본인및부모국적증명서 One Certificate of Citizenship (Applicant & Parents) 수상실적 ( 해당자만 ) Awards (Optional) 11 재외동포증명서류 ( 해당자만 ) Overseas Korean Documents (Overseas Koreans only) 12 한국어또는영어능력공인인증서 ( 해당자만 ) One Certificate of Korean or English Proficiency (If applicable) 1/3 C. of Korean Proficiency N/A C. of English Proficiency N/A

21 인적사항 (Personal Information) (English Name Spelling MUST be exactly the same as in your passport) 성명 (Full Name) 자국어 (Native language) 영어 * (English) 성 (Family Name) 이름 (Given Name) Middle Name 성 (Family Name) 이름 (Given Name) Middle Name 여권사진 (Passport Photo) 3cm 4cm 성별 (Gender) Male Female 생년월일 (Date of Birth: yyyy/mm/dd) 결혼여부 (Marital Status) Single Married 출생지 (Place of Birth) City/Province and Country 여권번호 (Current Passport Number) 국적 (Nationality) 여권유효기간 (Passport Expiration date) 자택 (Home) 출신고등학교 (High School) 주소 (Mailing Address) 전화 (Phone) 휴대전화 (Cell Phone) 이메일 ( ) 주소 (Mailing Address) 전화 (Phone) 팩스 (Fax) Please write in ENGLISH ONLY including street address, city, country and postal code. Country Code / Area Code / Phone Number Country Code / Cell Phone Number Please write in ENGLISH ONLY including street address, city, country and postal code. Country Code / Area Code / Phone Number Country Code / Area Code / Fax Number 언어능력 (Language Proficiency) 언어명 시험명 성적 시험일 수준 (Level) (Language) (Title of Test) (Score or level) (Date of Test) Beginning Intermediate Advanced 한국어 (Korean) 영어 (English) 학력 (Education: including Elementary School): Please list most recent first 입학일 (Entrance Date) ( yyyy/mm/dd) 졸업일 (Graduation Date) (yyyy/mm/dd) 기관명 (Institution) 소재지 (Location: city/country) 21

22 고등학교성적 (High School Grades; Only for the semesters attended) 학년 (School Year) 1 학년 (1 st year) 2 학년 (2 nd year) 3 학년 (3 rd year) TOTAL 백분율 (100 percentile) Grades (G.P.A.) C.G.P.A.: /100 RANK RANK: /100 가족사항 (Family Background) 관계 (Relationship) 성명 (Name: Family/Given/Middle) 생년월일 (Date of Birth) 직업 (Occupation) 거주지 (Address: district, city) 한국기관에서수여받은장학금 (Previous Scholarship Awards Received from Korean institutions) 장학금명 (Title of Award) 기간 : 연월일 (Period: yyyy/mm/dd) 지원기관 (Institution) 과거한국에서의거주또는체류사실 (Previous Visits to Korea) 기간 : 연월일 (Period: yyyy/mm/dd) 지역 (City or Region) 목적 (Purpose of Stay) 거주또는체류관련기관 (Organization Concerned) 추천인명단 (List of Recommenders) 성명 (Name) 지위 (Position) 소속기관명 (Organization) 전화 (Phone) 이메일주소 ( Address) THE ANSWERS I HAVE GIVEN ABOVE ARE TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE. IF MY ANSWERS CONTAIN ANY KIND OF FALSEHOOD, I WILL TAKE ANY LEGAL RESPONSIBILITY. DATE(yyyy/mm/dd):.. NAME OF THE APPLICANT SIGNATURE OF THE APPLICANT 22

23 [Form 2] KGSP Applicant Pledge As an applicant for the 2018 Korean Government Scholarship Program (KGSP) for Undergraduate Degree, I pledge to abide by the followings; Please read each article and check the box below (1) All documents I submitted to NIIED are true; (2) I will abide by all the Korean laws and ordinances; (3) I will respect and uphold the values of the Korean culture and society; (4) I will fulfill my responsibilities as a KGSP scholar to the best of my abilities; (5) I will not participate in any form of political activities; (such as organizing or joining a political party, attending political meetings, publishing articles and declarations, and organizing or participating in political demonstraions) (6) I will maintain financial integrity at a personal level; (7) I accept NIIED s decision concerning the undergraduate degree program and the Korean language program; (8) I understand it is not permitted to change the university, either for the Korean language program or for the degree program; (9) I will observe the regulations of NIIED and the university; and (10) I give permission to NIIED to use my personal information for KGSP I confirm that I read all of the above conditions. I also understand that the violation of any one of the above might result in the suspension or cancellation of the scholarship. NAME OF THE APPLICANT DATE(yyyy/mm/dd):. SIGNATURE OF THE APPLICANT 23

24 [Form 3] 자기소개서 (Personal Statement) < 지시문 : 자기소개서를 2페이지이내로서술식으로작성 (A4, 단면으로작성 ) 하되, 아래내용을포함하도록하며, 내용을잘알아볼수있도록타이핑을하거나인쇄하시오. 이지시문은숙지후삭제하시오.> <Instructions: please write no more than 2 pages on an A4 size format, one-sided only. The essay should include the following things and must be clearly typed or printed in black ink. Please remove the instructions after reading it. > - Motivations with which you apply for this program - Family and Education background - Significant experiences you have had; risks you have taken and achievements you have made, persons or events that have had a significant influence on you - Extracurricular activities such as club activities, community service activities or work experiences - If applicable, describe awards you have received, publications you have made, or skills you have acquired, etc. DATE(yyyy/mm/dd):.. NAME OF THE APPLICANT SIGNATURE OF THE APPLICANT 24

25 [Form 4] 수학계획서 (Study Plan) < 지시문 : 한국어또는영어로 3 페이지이내로 A4 규격용지에단면으로작성하시오. 수학계획서를작성하기전에학교선생님과수학목적과계획에대해상의하시길권장합니다. 이지시문은숙지후삭제하시오.> <Instructions: Please type or print in Korean or English not exceeding 3 pages on an A4 size format, one-sided only. It is advised that you discuss your academic goals and plans with your teacher before filling out this form. Please remove the instructions after reading it.> 성명 (Name) 국적 (Nationality) 출신고등학교 (Secondary school attended) 한국어능력 (Korean Proficiency) Advanced Intermediate Beginner) Family name / Given name / Middle name 생년월일 (Date of Birth:yyyy/mm/dd) 입학일 (Entry Date: yyyy/mm) 졸업일 (Graduation Date: yyyy/mm) 영어능력 (English Proficiency) Advanced Intermediate Beginner) 수학희망대학 (Preferred Universities) 희망전공 (Preferred Departments) A. 한국입국전후학위과정수학에필요한외국어 ( 한국어, 영어등 ) 능력을향상시키기위한계획 Study plans to improve foreign languages(korean, English, etc) required for taking a bachelor s degree course BEFORE and AFTER you come to Korea. 25

26 B. 학위과정수학계획 ( 대학및전공선택이유, 학업목표와계획, 수학후계획을기재하고, 진학희망대학별전공이다른경우에는분리하여기술하시오 ) Study plan for a bachelor s degree course (Please state the reason you choose such universities and departments (or majors), your academic goals, specific plans (including timeline) to achieve them, and future plan after completion of your study. In case that preferred departments (or majors) of the preferred universities are different, please mention about them separately.) DATE(yyyy/mm/dd):.. NAME OF THE APPLICANT SIGNATURE OF THE APPLICANT 26

27 [Form 5] Letter of Recommendation Type or print in English or Korean, not exceeding 2 pages in length. To be completed by the applicant: Please fill in your name and other information below. If possible, let your recommender know your study plan in Korea when ask him/her to write this letter. Please note that recommendation letters that are not sealed and signed will not be accepted. Applicant s Name: Current/Last (High) School: Date of Birth (yyyy/mm/dd) Desired Field of study Humanities & Social Sciences Natural Sciences & Engineering Arts and Physical Education Preferred Universities Preferred Departments (or Majors) To be completed by the recommender: Your frank and candid appraisal of the applicant will be highly appreciated in the process of selection of Korean Government Scholarship recipients and the admissions to a Korean university. Please make 3 photocopies of the letter after writing it and sign all copies (1 original and 3 photocopied letters) respectively. And please return them sealed in an official envelope which is signed across the back flap; otherwise, they are not valid. Name: Title, Position and Institution: Address: How long have you known the applicant and in what context? Telephone: Please assess the applicant's qualities in the evaluation table given below. Rate the applicant compared to other individuals whom you are familiar with. Truly Classification Exceptional Excellent Very Good Good Below Average N/A Top 2% Top 10% Top 25% Middle 50% Lower 25% Academic Achievement Future Academic Potential Integrity Responsibility/Independence Creativity/Originality Communication Skills Interpersonal skills Leadership 27

28 1/2 Please provide us with comments on the applicant s performance record, potential, or personal qualities which you believe would be helpful in considering the applicant s application for the proposed degree program. DATE(yyyy/mm/dd):.. NAME OF THE RECOMMENDER SIGNATURE OF THE RECOMMENDER 28

29 [Form 6] 자가건강진단서 (Self Medical Assessment) Please provide accurate information for the following questions. Note: Applicants are not required to undergo an authorized medical exam before passing the 2 nd round of selection; however, all candidates must take a comprehensive medical exam after the 2 nd round of selection (see FORM 7); all grantees must take another comprehensive medical check-up (including HIV, TBPE drug test) after coming into Korea in accordance with the requirements of the Korea Immigration Service and the KGSP. If the results show that any grantee is unfit to study and live overseas, he/she may be disqualified. 1 2 QUESTION YES NO EXPLAIN When and for what reason did you last consult a physician? (Please explain) Have you had any serious ailment, injuries or diseases (high blood pressure, diabetes, tuberculosis, any type of Hepatitis, HIV, etc) in the last five years? (If yes, please explain) 3 Have you been hospitalized in the last two years? (If yes, please explain) 4 Have you ever been treated by a doctor for any mental, emotional, or anxiety disorder? (If yes, please explain and attach a report from your doctor) 5 Have you ever been addicted to any substance? (If yes, please explain) 6 Do you have any allergies? (If yes, please list them) 7 Do you have any visual or hearing impairment? 8 Do you have any physical disabilities? 9 Do you have any cognitive/mental disabilities? 10 Are you taking any prescribed medication? (If yes, please explain) 11 Are you on a special diet? (If yes, please explain in detail) 12 Have you ever suffered from depression? (If yes, please explain) THE ANSWERS I HAVE GIVEN ABOVE ARE TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE. IF MY ANSWERS CONTAIN ANY KIND OF FALSEHOOD, I WILL TAKE ANY LEGAL RESPONSIBILITY. Date(yyyy/mm/dd):.. NAME OF THE APPLICANT SIGNATURE OF THE APPLICANT 29