Application for admission

APPLICATION FOR ADMISSION

Note: Please type or print in block letters in English.

1. Name in Full:

(Vernacular)

Last Name First Name Middle Name(if any)

(English) Mr./Ms. Kim Roman

(Last Name) (First Name) (Middle Name)

(Korean) 김 로만

(Last Name) (First Name) (Middle Name)

2. Marital Status (check one): Single X Married3. Gender (check one): Male X Female

4. Nationality: Korean 5. Date of Birth: (DD) 30 (MM) 07 (YY) 97

6. Place of Birth: Uzbekistan, Tashkent

Photo

(4cm´5cm)

7. Permanent Address: Tashkent,S.Baraka 3-57

Zip Code

8. Mailing Address: 서울 특별시 용산구 한강대로 72길 21-7

Zip Code

9. E-mail Address: [e-mail]

10. Telephone:

11. Local Telephone(within Korea): 010-8280-2032

12. Present Occupation:

13. Education (Academic history starting from elementary school):

※Please write name, address, phone number, fax number, and e-mail address of all schools attended from elementary to highest education obtained.
Dates (From-To)	Name of School	Address	Tel	Fax	E-mail	Required Years of Study	Major	Diploma or Degree

14. Employment History (In chronological order):

Dates (From-To)	Name & Address of Organization	Position	Type of Work

15. Language Proficiency

Languages	Excellent	Good	Fair	Poor
Korean			X
English		X

16. Person to be notified in the applicant’s home country in case of emergency:

Name in Full:

Address:

Telephone, Telex or Fax No:

E-mail:

I declare that the information contained above is accurate and true. If there is any falsity in the submitted materials, I will take a full responsibility.

Date of Application: 26.09.15

Applicant’s Name: Kim Roman

Applicant’s Signature: Kim

Дата добавления: 2015-11-04