[Form 1]

2014
(Application for 2014 KGSP for an Undergraduate Degree
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. #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

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A Checklist (Submission of Documents)
Please put a . in the appropriate box! Type or Print clearly
Required Documents Original
Document
Official
Notarized
Translation
3 Copied
Documents
Yes No Yes No Yes No
1 One Complete Application Form N/A
2 j One NIID !ledge N/A
Z klm One !ersonal "tatement N/A
4 W<n One "tud# !lan N/A
o pq $ $ Recommendation %etters &from $ different recommenders' N/A
r stuvw One !ersonal (edi cal Assessment N/A
x y`z {|} One )raduation Certificate of *ig+ sc+ool
~ y`z &0} One *ig+ sc+ool )rade Transcripts
0 } One Certificate of Citizens+ip &Applicant , !arents'
10 Q VQ NR I } &'
One Certificate of -orean or nglis+ !roficienc#
&If applica.le'
C/ of -orean !roficienc# N/A
C/ of nglis+ !roficienc# N/A
0/3
A 0 C
(Per!onal "nformation &nglis+ Name "pelling (1"T .e e2actl# t+e same as in #our passport'
&
&Full Name'
Q
&Nati3e
language'
Cv
&!assport !+oto'
3cm 45cm
&&Famil# Name' *+&)i3en Name' (iddle Name
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&nglis+'
&&Famil# Name' *+&)i3en Name' (iddle Name
&
&)ender'
(ale
Female
345&Date of 7irt+8 ####/mm/dd'
&(arital "tatus' "ingle Married

&!lace of 7irt+'

Cit#/!ro3ince and Countr#

&Current !assport Num.er'

0
&Nationalit#'
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&!assport 2piration date'

&*ome'
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&(ailing
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&!+one'

Countr# Code / Area Code / !+one Num.er
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&Cell !+one'
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Countr# Code / Cell !+one Num.er
*5
&<mail'
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&(ailing
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!lease 9rite in N)%I"* ON%Y including street address: cit#: countr# and postal code/
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&!+one'

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

&Fa2'

Countr# Code / Area Code / Fa2 Num.er
A PQNR
(#anguage Proficienc$
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&%anguage'

&Title of Test'
&0
&"core or le3el'
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&Date of Test'
W&%e3el'
7eginning Intermediate Ad3anced
Q &-orean'
VQ &nglis+'

A R
(%ducation& including %lementar$ Sc'ool& !lease list most recent first
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&ntrance Date'
& ####/mm/dd'
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&)raduation Date'
&####/mm/dd'
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&Institution'
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&%ocation8 cit#/countr#'
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((ig' Sc'ool Grade!) *nl$ for t'e !eme!ter! attended
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&"c+ool Year'
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&Name8 Famil#/)i3en/(iddle'
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&Date of 7irt+'
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&Occupation'

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A k W
(Pre3iou! Sc'olar!'ip A4ard! /ecei3ed from Korean in!titution!

&Title of A9ard'
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&!eriod8 ####/mm/dd'
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&Institution'

A - M C
(Pre3iou! 5i!it! to Korea
k H45
&!eriod8 ####/mm/dd'

&Cit# or Region'
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&!urpose of "ta#'
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&Organization Concerned'

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(#i!t of /ecommender!
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&Name'

&!osition'
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&Organization'
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&<mail Address'
T* AN"=R" I *A> )I>N A7O> AR TR1 AND CORRCT 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/
DA+%($$$$.mm.dd& - -
0A6% *F +(% APP#",A0+ S"G0A+U/% *F +(% APP#",A0+
3/3
[Form 2]
j

(Pledge
C jY
&0'
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CD a *h (0 D
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As a grantee of t+e $?05 -orean )o3ernment sc+olars+ip program for an undergraduate course: I pledge
to a.ide .# t+e follo9ing rules@
&0' To refrain from 3iolation of uni3ersit# regulations: and to fulfill m# o.ligations as a student to t+e
.est of m# a.ilit#/
&$' To .e+a3e in a manner appropriate to t+e -orean culture and societ#: and not to participate in an#
form of political acti3it# &suc+ as organizing a political part#: Aoining a political part#: attending
political meetings: pu.lis+ing political articles and declarations: organizing or participating in
demonstrations of a political nature: and so on'/
&3' To accept responsi.ilit# for pa#ing an# de.ts incurred in -orea
&5' To a.ide .# NIIDBs polic# concerning t+e -orean language course and t+e degree course 9it+out
an# o.Aection/
&C' To a.ide .# all of t+e terms and regulations set .# NIID/
&D' To agree to t+e use of m# personal information &name: contact num.er: institutions I .elong to: etc'
9+en it is needed for t+e operation of t+e program or upon t+e request of ot+er go3ernmental
institutions/
If I am pro3ed to +a3e 3iolated an# of t+e a.o3e articles: to +a3e made a false statement in m#
application documents or to +a3e failed to compl# 9it+ academic standards or t+e rules of uni3ersit#: I
s+all accept t+e decision of NIID: e3en t+oug+ it ma# include t+e suspension or re3ocation of t+e
sc+olars+ip/
DAT&####/mm/dd'8 / /
NA( OF T* A!!%ICANT "I)NAT1R OF T* A!!%ICANT
[Form 7]
k l m
(Per!onal Statement
<: 2 (A4, ), ,
!" # $ %& '( )*+. , - . /0+.>
<Instructions: please write not exceeding 2 pages on an A4 size format, onesided onl!. "#e essa! s#ould contain t#e
following t#ings and must $e clearl! t!ped or printed in $lac% in%. &lease remo'e t#e instructions after reading it. >
(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$lications !ou #a'e made, or s%ills !ou #a'e ac,uired, etc.
DAT&####/mm/dd'8 / /
NA( OF T* A!!%ICANT "I)NAT1R OF T* A!!%ICANT
[Form 4]
W < n
(Stud$ Plan
<B: Q VQ - * * A4 w &. W<n &k [ z
- W 0- <n . * B .>
<Instructions: &lease t!pe or print in .orean or +nglis# not exceeding - pages on an A4 size format, onesided onl!.
It is ad'ised t#at !ou discuss !our academic goals and plans wit# !our teac#er $efore filling out t#is form. &lease
remo'e t#e instructions after reading it.>
&
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"tud# plans to impro3e foreign languages&-orean: nglis+: etc' required for taEing a .ac+elorFs degree course
/+012+ and A0"+2 !ou come to .orea.
6Y - W <n ( [I *h | <nh W <n kyh v :; [I*
k%
"tud# plan for a .ac+elorFs degree course &&lease state t#e reason !ou c#oose suc# uni'ersities and departments (or
ma3ors), !our academic goals, specific plans (including timeline) to ac#ie'e t#em, and future plan after completion of !our
stud!. In case t#at preferred departments (or ma3ors) of t#e preferred uni'ersities are different, please mention a$out t#em
separatel!.)
DAT&####/mm/dd'8 / /
NA( OF T* A!!%ICANT "I)NAT1R OF T* A!!%ICANT
[Form 8]
#etter of /ecommendation
/ Type or print in English or Korean! not exceeding 0 pages in length.
+o 9e completed 9$ t'e applicant&
&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%
#im4#er to write t#is letter. &lease note t#at recommendation letters t#at are not sealed and signed will not $e accepted.
ApplicantFs Name8
Current/%ast &*ig+' "c+ool8
Date of 7irt+ &####/mm/dd' <mail8
Desired Field of stud# G *umanities , "ocial "ciences G Natural "ciences , ngineering G Arts and !+#sical ducation
!referred 1ni3ersities
!referred Departments &or
(aAors'
<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<
+o 9e completed 9$ t'e recommender&
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 <mail8
Title: !osition and Institution8
Address8
Telep+one8
*o9 long +a3e #ou Eno9n t+e applicant and in 9+at conte2tH

!lease assess t+e applicantBs qualities in t+e e3aluation ta.le gi3en .elo9/ Rate t+e applicant compared to ot+er
indi3iduals 9+om #ou are familiar 9it+/
Classification Trul#
2ceptional
2cellent >er# )ood )ood 7elo9 A3erage N/A
Top $I Top 0?I Top $CI (iddle C?I %o9er $CI
Academic Ac+ie3ement
Future Academic !otential
Integrit#
Responsi.ilit#/Independence
Creati3it#/Originalit#
Communication "Eills
Interpersonal sEills
%eaders+ip
0/$
!lease pro3ide us 9it+ comments on t+e applicantFs performance record: potential: or personal qualities 9+ic+ #ou
.elie3e 9ould .e +elpful in considering t+e applicantFs application for t+e proposed degree program/
DAT&####/mm/dd'8 / /
NA( OF T* RCO((NDR "I)NAT1R OF T* RCO((NDR
$/$
[Form :]
s t u v w
(Per!onal 6edical A!!e!!ment
&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
selection@ +o9e3er: all candidates must taEe a compre+ensi3e medical e2am after t+e $
nd
round of selection
&see 012( 8'@ all grantees must taEe anot+er compre+ensi3e medical c+ecE<up &including *I>: T7! drug
test' after coming into -orea in accordance 9it+ t+e requirements of t+e -orea Immigration "er3ice and t+e
-)"!/ If t+e results s+o9 t+at an# grantee is unfit to stud# and li3e o3erseas: +e/s+e ma# .e disqualified/
J1"TION Y" NO K!%AIN
0 =+en and for 9+at reason did #ou last consult a
p+#sicianH &!lease e2plain'
0 *a3e #ou +ad an# serious ailment: inAuries or diseases
&+ig+ .lood pressure: dia.etes: tu.erculosis: an# t#pe of
*epatitis: *I>: etc' in t+e last fi3e #earsH &If #es: please
e2plain'
$ *a3e #ou .een +ospitalized in t+e last t9o #earsH
&If #es: please e2plain'
3 *a3e #ou e3er .een treated .# a doctor for an# mental:
emotional: or an2iet# disorderH
&If #es: please e2plain and attac+ a report from #our
doctor'
5 *a3e #ou e3er .een addicted to an# su.stanceH
&If #es: please e2plain'
C Do #ou +a3e an# allergiesH &If #es: please list t+em'
D Do #ou +a3e an# 3isual or +earing impairmentH
L Do #ou +a3e an# p+#sical disa.ilitiesH
M Do #ou +a3e an# cogniti3e/mental disa.ilitiesH
N Are #ou taEing an# prescri.ed medicationH
&If #es: please e2plain'
0? Are #ou on a special dietH
&If #es: please e2plain in detail'
00 *a3e #ou e3er suffered from depressionH
&If #es: please e2plain'
T* AN"=R" I *A> )I>N A7O> AR TR1 AND CORRCT 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&####/mm/dd'8 / /

NA( OF T* A!!%ICANT "I)NAT1R OF T* A!!%ICANT