Application Form

ASEAN Leaders Fostering Program2013/2014

  1. PERSONAL INFORMATION

Name(as stated on the passport)

______

FIRST NAMELAST NAME

Citizenship(Nationality)______

Date of Birth ______Age ______Sex: M / F

Religion______

Passport Number ______Place of Issue______

Issued Date______Expired Date______

Permanent Address______

______

Telephone: (_____)______Fax(_____)______

Mobile Phone: (______)______

Present Address (If different) ______

______

Telephone: (_____)______Fax(_____)______

Email ______

※Please attach your resume

II. Educational Background

Faculty/Department______

Major______School Year______

University ______

University Address______

______

Telephone (______)______Fax: (______)______

Grade Point Average ______/______ex) 3.8/4.0

*Please provide your original maximum and earned GPAS and transformed one’s on 4.0scale

2. Level of Language Ability (please circle one)

English: Poor,fair,good, excellent

(※If you have the Proficiency Test Result,

Name of the test : Score:)

Korean: Poor, fair,good, excellent

(※If you have the Proficiency Test Result,

Name of the test : Score:)

Other Language (please specify, if any)______

(※If you have the Proficiency Test Result,

Name of the test : Score:)

3. Identify any exchanged programs you have attended over last 5 years;

3.1 Name of the Program______

Country______Duration______

Name of the University or Institution______

Field of Study ______

Name of the organizer______

3.2 Name of the Program______

Country______Duration______

Name of the University or Institution______

Field of Study ______

Name of the organizer______

3.3 Name of the Program______

Country______Duration______

Name of the University or Institution______

Field of Study ______

Name of the organizer______

4. Identify any awards you have received;

______

______

______

______

______

5. Identify any activities you have done for your University;

______

______

______

______

______

III. STATEMENT OF INTENT

* If necessary, you can use separate pages to provide following information

1)Areas of Interest (Please indicate below the area(s) of study in which you are interested to enroll during your stay at Daejeon University):

2) Goals and Objectives (What do you hope to accomplish through this program?):

IV. ESSAY

In the era of globalization, where borders are getting less relevant, how can we prevent Transnational Crimes without compromising the smooth people mobility?

Please submit on a separate paper with no more than 1,000 words.

V. OTHER NECESSARY DOCUMENTS

PLEASE SUBMIT THE FOLLOWING DOCUMENTTOGETHER WITH YOUR APPLICATION (your application will not be considered without the following materials):

A.*A STATEMENT OF INTENT TO RETURN

(Certified by your university)

B.COMPLETED MEDICAL QUESTIONNAIRE

C. AN ORIGINAL TRANSCRIPT(in ENGLISH)

  1. RESUME OR BRIEF BIODATA
  2. TWO ADDITIONAL PHOTOS(35×45mm)
  3. LANGUAGE PROFICIENCY TEST RESULT(Optional)

Ⅵ. REFERENCE

Please provide us with comments on the applicant’s strength, weakness or personal qualities which youbelieve would be helpful in considering the applicant’s application for this program.

Please provide the name of your recommender.

Name: ______

Position: ____________

Address______

Telephone: ______Fax: ______

I, the undersigned, hereby acknowledge, under the penalty of perjury, that the foregoing information is true and correct to the best of my knowledge.

Applicant Signature Dated

______

Authorized Person Signature Dated

(Preferable Director of International Relation Office)

______

Position ______

************************

MEDICAL QUESTIONNAIRE

Name of Applicant:
Age:Sex (M / F)Height: Weight:
1) If the applicant has had a history of illness or other disorders during the last 5 years, please describe treatment and present status.
2) List any abnormalities indicated in the chest X-ray.
3) What is the applicant's normal blood pressure?
4) Is the applicant free from infectious disease (AIDS, tuberculosis, trachoma, skin disease, etc.)?
5) Is the applicant able physically and mentally to carry on intensive training away from his/her home?
6) Describe the applicant's overall health condition (include remarks of the examining physician).
7) Name and Address of the Clinic/ Hospital______
______
______
Date______
Name of Physician: ______
Signature:______
Date______Signature of Application:______

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