Korean Culture and Language Immersion Program: K-CLIP 2015

Korean Culture and Language Immersion Program: K-CLIP 2015 Application Form

Photo (* Optional) (3.5 cm× 4.5cm)

Name (same as your passport)

(Family Name)

(Given Name)

Date of Birth

(mm/dd/yy)

Occupation

Nationality

Gender

Female £

Male £

Passport No.

Issue Date

Expiration Date

Current Mailing Address

E-mail

Do You need a visa to travel to Korea?

Yes £

No £

Education Background

Name of School:

College / University

Entrance / Graduation (mm/dd/yy): /

Major:

Address:

Master / Doctorate

Name of School:

Entrance / Graduation (mm/dd/yy): /

Major:

Address:

Korean Language Proficiency Level

How Long Have you studied Korean? _________________ Fluency in Korean: None £ Elementary £ Intermediate £ Advanced £

Emergency Contact (in your country)

Family Name

Given Name

Relationship

E-mail

Mailing Address

Tel No. (office)

Cell Phone

Indicate a person (including yourself) or organization that will be responsible for your Participation Fee

Family Name

Given Name

Occupation

E-mail

Relationship

Mailing Address

Tel No. (office)

Cell Phone

※ Cancellation & Refund Policy for Participation Fee * 30days before the event: Full refund * 15 to 29 days before the event: 50% refund * Less than 14days before the event: No refund I hereby certify that all above information is true and correct. I will follow all the regulations while I participate at the Korean Culture and Language Immersion Program 2015. Date: (Month/Date/Year) Applicant: Signature:

* Please send back the completed form to TPO Secretariat through

Fax: [phone] or E-mail: [e-mail]

** We request you to kindly send us the copy of the photo page of your passport together with the application form (for a procedure of preparing a private accident insurance - GPAI)

Дата добавления: 2015-08-27