Please Type or Print Legibly in Black Ink STUDENT INFORMATION Date of Birth Student Name Educational Background / / ( ) Male ( )Female Month Day Year

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1 APPLICATION CHECKLIST 1. 입학원서 ( 영문, 국문 ) 2. 재학증명서 ( 영문 ) 3. 성적증명서 ( 영문 ) 4. 가족관계증명서 5. 주민등록등본 6. 사진 5 매 ( 반명함 - 배경흰색 ) 7. 여권복사 8. 부모학생동의서 ( 서명 ) 9. 수업료 Deposit 1

2 Please Type or Print Legibly in Black Ink STUDENT INFORMATION Date of Birth Student Name Educational Background / / ( ) Male ( )Female Month Day Year Family Name First ( ) Elementary School ( ) Middle School (attending / graduated) If attending, grade ( ) ( ) High School (Grade ) Address Street City Birth place Mother Name City Province Postal Code Telephone Country Country Code Area Code Number Citizenship Country Father Name Occupation Work Telephone Number Cell Phone Number Address Occupation Work Telephone Number Cell Phone Number Address Siblings Relationship Name Age At home? (Yes/No) Gender 2

3 STUDENT QUESTIONNAIRE To be completed in English by the participant 1.How do you feel your education and society differ from American education and society? 2. Describe your relationship with your parents, brothers and sisters. 3. What activities do you generally take part in with your family? 4. Why do you wish to participate in American program? 5. What are your academic and career goals? (If undecided, discuss the possibilities that you are considering.) 3

4 STUDENTS ACADEMIC AND EDUCATIONAL INFORMATION To be completed by the participant. 1. What is current grade level? ( ) Freshman ( )Sophomore ( )Junior ( ) Senior 2. What is your favorite program? 3. What is your least favorite program? 4. Do you intend to go to a college? ( ) Yes ( ) No If yes, what country do you intend to study in? And, what do you intend to major? 5. What foreign language(s) have you studied? How would you rate your ability, using E=excellent, G=good, F=fair, and P= poor? Language Years Studied Reading Writing Speaking Listening 6. Describe briefly your foreign travel and other international experiences, if any. Indicate whether you travelled with or without your family. 7. What do you expect to gain from SPDCA? Full name of Student (Please Print) Signature of Student Date 4

5 지원학년 입학년도 성명 한글 영문 성별생년월일주민등록번호학생연락처부모님연락처 국적 : 대한민국 병역사항 종교 주소 Tel HP 주소 Tel HP 학교졸업 / 재학비고 학력사항 영어 ( 공인점수 ) TOEFL/TOEIC/TEPS: 관계성명생년월일직업연락처기타 가족관계 비고 위와같이입학지원서를작성합니다. ( 한글로작성 ) 작성자서명날짜 5

6 MEDICAL INFORMATION AND INOCULATION RECORD To be completed, signed and dated by a physician. Student Name Date of Exam Family Name First Middle The student must have a physical examination by a licensed physician, who is not a family member, within the 6 months preceding school enrollment. The physician should complete this report on the applicant s medical history, current health and immunization. PART I - MEDICAL HISTORY Has the applicant ever had a history of any of the following: Yes No Yes No Yes No Yes No Allergies Eating disorder Measles Polio Appendicitis Enuresis Mumps Scarlet Fever Appendix removal Headache Menstrual disorder Seizure disorder Asthma Hepatitis Parasites Sleep disorder Chicken pox Goiter Pneumonia Tonsils Removal Cough (persistent) Hernia Rheumatic fever Tuberculosis Diabetes Mellitus Malaria Rubella; Year: Vertigo Any disease, impairment or abnormality of: Yes No Yes No Yes No Yes No Digestive system Ears, Hearing Locomotor system Varicose veins Bones, joints Genito-Urinary Lungs Tonsils, throat Brain, Nervous system Menstrual cycle nose system Heart, Blood Skin (acne, etc.) Immune System Blood, Endocrine vessels system Has the applicant had any of the following: Yes No Yes No Yes No restriction of a physical treatment or counseling for a difficulty with school studies or activity during the past five nervous condition, personality, teacher years character disorder or emotional problems Please give a detailed explanation of any of the items above marked yes. Has the applicant ever been hospitalized: Yes No If yes, please give the date and diagnosis of each illness or accident. Is the applicant taking any medication at this time? Yes No If yes, please list medication(s) and reason(s). 6

7 MEDICAL INFORMATION AND INOCULATION RECORD (continued) PART II - PHYSICAL EXAMINATION OF STUDENT Height (m) Weight (kg) Blood Pressure Does the student wear contact lenses? Yes No Does the student wear glasses? Yes No Applicant s uncorrected vision: R / L / With correction: R / L / Hearing: R / L / With correction: R / L / Are there any current abnormalities of the following systems? If yes provide additional information. Yes No Yes No Yes No Cardiovascular system Menstrual Cycle Respiratory System Ears, Nose, Throat Musculoskeletal Skin (acne, etc.) Eyes Metabolic/Endocrine Teeth and Gums Gastrointestinal Neuropsychiatric Other Genito-Urinary System Pelvic Is the student now under treatment for any medical or emotional conditions? Yes No If yes, please explain: Does the student have an eating disorder or a history of eating disorder? Yes No If yes, please explain: Recommendation for physical activity: Unlimited Limited (please explain) Your opinion on the student s state of health: Excellent Good Fair Poor Guardian/Parent Full Name Guardian/Parent Signature Date 7

8 Polio MEDICAL INFORMATION AND INOCULATION RECORD (continued) PART III - Immunization Record According to Minnesota State Law, all students must receive certain immunizations. Therefore, a student will not be enrolled in classes at Saint Paul Daechi Academy unless he/she has received all of the required vaccinations. Instructions: 1. This form must be completed by a physician. 2. For each vaccination/test, the month, day, and year must be recorded. Attach additional documentation as necessary. 3. If the student has had the disease, the date and treatment should be recorded in the appropriate column. 4. Carefully review the guidelines for each inoculation to determine if the student has received the required number of doses. Type of Vaccine Requirement: at least 3 doses. Diphtheria, Tetanus, and Pertussis (DTaP, DTP) Tetanus Diphtheria (Td) Pertussis 1st Dose Mo/Day/Yr 2nd Dose Mo/Day/Yr 8 3rd Dose Mo/Day/Yr 4th Dose Mo/Day/Yr 5th Dose Mo/Day/Yr History of Disease Date/Treatment Requirement: At least 3 DTP doses AND one Td shot at age 11 or older. However, If a Td was given after the 7th birthday, it must be repeated 10 years after the last dose. Note: If student has not been vaccinated for Pertussis, he/she does not need to be (children age 7 and older are not given this vaccine). Measles, Mumps, Rubella (MMR) Requirement: 2 doses, both given after 12 months of age. If the first dose was administered prior to the student s first birthday, a third dose is required. Hepatitis B (Hep B) Requirement: 3 doses. A 3rd dose is not required if documentation of the alternative 2-dose schedule is provided. Varicella (Chickenpox) This immunization is not required, but is recommended for students who have not had chickenpox disease. Please indicate history of this disease above. Bacillus Calmette-Guerin This is not a required nor recommended vaccination. Other: TB Skin Test (Mantoux) Date Given (Mo/Day/Yr): Results: mm positive negative Chest X-ray Date Given (Mo/Day/Yr): Time Given: Results/Treatment: Date Read (Mo/Day/Yr): Time Read: Requirement: Student must have a TB test within 6 months prior to starting academic year. If TB Skin Test is positive, the student must have a chest x-ray and submit the results to the academy.

9 To be read, signed and dated by the student and both parents or legal guardians. PARENT AND STUDENT AGREEMENT To be read, signed and dated by the student and both parents or legal guardians 세인트폴아카데미대치는전세계의학생들에게인성과지성을겸비한글로벌엘리트를육성시키는데있습니다. 건전한면학분위기를위해서다음과같은사항을준수하도록합니다. 이기준을위반하는경우징계조치가취해지거나퇴원될수있습니다. 학생행동수칙 1. 강의실내행동 : 학생들은무서또는구두로설명된세인트폴아카데미대치의모든규율을준수해야합니다. 선생님들은강의시간내에추가적으로행동규율을지정할권리를가지고있습니다. 학생들은이모든것들을준수하도록요구됩니다. 2. 폭력 : 폭력은어떤다른사람으로하여금위협하거나공포를느끼게하는공격적인행위입니다. 어떤이유가수반되어도용서되지않습니다. 3. 음주 : 건물내에서는음주가불가하며퇴원조치될수있습니다. 4. 흡연 : 건물내에서흡연을할수없으며, 전자담배또한금지되어있습니다. 5. 약품 : 학생은항정신성의약품및법에접촉되는약품을사거나, 팔거나, 소지하거나, 사용할수없으며의사또는건강전문가에의해처방되지않은약을절대사용할수없습니다. 6. 파손 : 강의실기물및시설에대한파손은등가현금보상이원칙이며보상되지않을시에는어학원에서의기록이제공되지않습니다. 7. 복장 : 강의실내모자, 선글라스, 슬리퍼와소매없는상의와지나친노출의복은삼가합니다. 8. 점심은외출이가능하나, 저녁은어학원내에서식사합니다. 9. 불건전한행위 : 강사또는교직원에대한무례함, 경멸, 차별대우, 위협적인행위등은용납되지않습니다. 이행위는물리적, 구두, 온라인, 서면등모든행위에해당됩니다. 10. 애정표현 : 건물내에서의학생간의애정표현은금지합니다. 11. 음식과음료수 : 음식, 음료, 껌등은선생님의허락없이강의실내에서허용되지않습니다. 9

10 강의준수사항 1. 스케쥴 I 은월 ~ 금요일오전 9:00 ~ 오후 3:50 에따르게됩니다. 스케쥴 II 는월수금오전 9:00 ~ 오후 10:00, 화목은오전 9:00 ~ 오후 6:30 에따르게됩니다. 2. 출석 / 결석 : 학생은세인트폴아카데미대치에서의모든규칙을준수해야하며, 강의에정해진시간에출석해야합니다. 한 Program 에서 3 번이상지각을할경우, 이는 1 회의결석으로처리됩니다. 8 주동안 3 일의무단결석이있을경우, 재수강해야합니다. 질병으로결석할경우는의사의소견서를제출하여야합니다. 조퇴는교수부장에게알린후부모님의유선동의가있어야합니다. 3. 학습태도 : 학생들의학업상황, 출석상황, 수업태도등의합산점수및경고여부는집계하여부모님께통보됩니다. 또한매시기기준이하의학생에게는주의및경고조치를합니다. 수업에방해를주는행동을할경우, 선생님은학생을퇴원조치할수있습니다. 4. 전자기기 : 학생들이교육적인목적으로전자기기 ( 노트북, 태블릿 ) 를사용하여인터넷을이용하는것을권장하고있습니다. 그러나수업시간에허용되지않는경우를불구하고전자기기사용이적발될경우그에따른단계적처벌을받게되며, 계속적으로수업중사용하여수업에방해를줄경우선생님은퇴교조치할수있습니다. 핸드폰은수업시간중절대사용금지되어있습니다. 학생복장과용모 (Dress code) 학생들의복장과용모는세인트폴아카데미대치의규정에따릅니다. 1. 상의 : 소매없는옷은삼가합니다. 2. 하의 : 과도하게짧거나지나친노출의치마와바지는삼가합니다. 3. 모자 : 건물내에서는삼가합니다. 4. 선글라스 : 건물내에서는삼가합니다. 5. 머리염색 : 전체탈색, 원색의염색, 전체이발, 남학생의경우지나친장발은삼가합니다. 6. 액세서리 : 피어싱은삼가합니다. 7. 문신 : 노출된신체부위의문신은삼가합니다. 8. 메니큐어 : 진한색의메니큐어는삼가합니다. 9. 슬리퍼는건물내에서착용을삼가합니다. 10

11 [ 참조 ] 원비환불규정 1. 7 월말까지모든비용이납부되어야합니다. 2. 학생이원내규칙불이행으로퇴원조치될경우, 학원비반납은원내반환규정을따릅니다. 세인트폴아카데미대치에입학하기원하는학생과학부모님들은이와같은사실을인지, 확인한후에동의합니다. 학생으로서학원의규칙및규범을존중하고따를것이며, 학생이이와같은규정을위반할때는, 세인트폴아카데미대치의규정대로처리함에이의를제기하지않을것을동의합니다. Signature of the father/legal guardian Print father s/legal guardian s full name Date Signature of the mother/legal guardian Print mother s/legal guardian s full name Date Signature of student Print student s full name Date 11

4. Scholarship Award Category: - Hangul Grand Scholarship: Certificate + Scholarship of $300 - King Sejong Scholarship: Certificate + Scholarship of $

4. Scholarship Award Category: - Hangul Grand Scholarship: Certificate + Scholarship of $300 - King Sejong Scholarship: Certificate + Scholarship of $ 2016 Korean Language Class Student Scholarship Korean Education Center in Los Angeles (KECLA) would like to inform outstanding Korean language class students to participate in 2016 Korean