Consent Form for Processing the Personal Information (Scholarship Candidates)

Consent Form for Processing the Personal Information (Scholarship Candidates)

The following is a consent form for processing personal information of scholarship candidates by the Samsung Dream Scholarship Foundation (the “foundation”) required for processing applications, selecting scholarship students and providing scholarship support. Please review carefully the sections that apply to you and indicate whether you consent to each item in the relevant shaded area.

Consent to Collection and Use of Personal Information

Consent to Collection and Use of General Personal Information

Personal Information for Mandatory Collection and Use

The following items of personal information will be used by the Foundation in order to receive support from the Foundation. Such personal information shall be used until the purpose of collection and use, as set below, is achieved (subject to superseding applicable law). In the event that your application is turned down, for the purpose of managing records regarding disqualified candidates, your application form shall be retained for one (1) year and other items managed by computer for five (5) years). You have the right to refuse consenting to the mandatory collection and use of your personal information, but you may be excluded from the scholarship program in such case.

Items to be Collected / ‣Matters Concerning Personal Affairs
: Name, gender, date of birth, nationality, address (of residences both in homeland and in Korea), contact information (phone number/e-mail address), photo, family information (name, relationship, age and occupation of and with family member), other scholarship benefits and the amount thereof, grade transcript, score certificate of foreign language test (Korean/English) and financial situation of parents (breakdown of salary and other particulars).
‣Matters Concerning Application for Scholarship
: Name of university/college, department, major, admission year, semester to which you are promoted, information of reference teacher, scanned file of application letter and reward achievements.
Purpose of Collection and Use / ‣Selection of scholarship students.
‣Participation inscholarship and voluntary work programs (attending certificate presentation ceremonies, scholarship students’ memoirs, camp events, Korean language classes, etc.)
‣Internal use by the Foundation, including management of selected scholarship students after selection, payment of scholarship, management of records, assessment on continuous promotion of business and statistical analysis, etc.
□I have fully understood the Foundation’s explanation regarding the collection and use of personal information and hereby consent thereto.

Personal Information for Optional Collection and Use

Certain general personal information of scholarship candidates (e.g. name, gender, family background, future career status, other situation regarding application for scholarship, etc.) will be transferred by the Organization to the Foundation for the purpose of promoting the Foundation (such as publishing model reports, webzine and annual/research reports, etc.), which may be disclosed. You have the right to refuse the optional transfer and disclosure.

□I agree to the optional collection and use of personal information. □I disagree.

Consent to the Transfer of Personal Information to a Third Party

1. Personal Information for Mandatory Transfer

The following items of personal information must be provided to a third party for you to be selected as a scholarship student, receive scholarship funding and receive support from the Foundation. You have the right to refuse the mandatory transfer, but you may be excluded from the scholarship program in such case.

Recipient Name / Recipient’s Purpose of Using the Personal Information / Items of Personal Information to be Transferred / Period of Retention and Use by Recipient
Scholarship department of school that a candidate filled in or currently belongs to / Verify current scholarship status / Name, major, grade, cell phone number, address and e-mail address. / Until the purpose of using the personal information is achieved
Organization, individual, institution, school and others to which a candidate provides voluntary service.
(In this regard, the Foundation will decide and specify a recipient beforehand with the candidate bytelephone to verify the transfer of information.) / Contact regarding volunteer work, etc. / Name, school, major, grade, address, cell phone number and e-mail address. / Same as above
Reference whom a candidate filled in / Selection of scholarship students and undertake each program. / Share all of the items specified in the Personal Information for Mandatory Collection and Use as above. / Same as above
□I have fully understood the Foundation’s explanation regarding the transfer of personal information and hereby consent thereto.

2. Personal Information for Optional Transfer/Disclosure

□I agree to the optional transfer/disclosure of generalpersonal information. □I disagree.

In the event you provide personal information of a third party including your family members or relatives (“Information Principal”) to the Organization and the Foundation for the purpose of being considered for scholarship by the Organization, the Foundation, etc., you shall fully explain to the Information Principal prior to providing their personal information of the fact that his/her personal information will be provided to the Organization and the Foundation, the items to be provided, the purpose of provision and period of retention and use by the Organization and the Foundation, and then obtain the Information Principal’s consent thereto.

By signing this Consent Form or consenting electronically, I hereby testify that I explained the above to the relevant Information Principal and obtained legitimate consent from the latter.

I have carefully read and sufficiently understood the above information. Because I expressly consent on my own free will, I hereby affix my signature below.

. . 2016
Name (print):
Signature: ______

<Form 1-1>

Application Form for Global-Hope Scholarship (Undergraduate)

Name of the
University / Department
/Major
Entrance Year/Month / E.g.) March, 2016
Personal
Information / Photo / Last Name / Gender / □ Male
□ Female
First,Middle
Name
Nationality
Date of Birth
Home Address
Current Address
(in Korea)
Tel/Mobile No.
E-mail
Family
Information / Name / Relationship / Age / Occupation
Other Scholarships
Receiving (during studying in Korea) / Amount
Period of Receiving Other Scholarships
1. Forms to Submit
1) Self-Introduction and Study Plan <Form 1-2>
2) Letter of Recommendation <Form 1-3>
2-1. RequiredDocuments
1)Transcript
Enrolled students: High school and University(undergraduate school) transcripts
Freshman : High school transcripts or(and) University(undergraduate school) transcripts
2) Official documents that can verify academic performance or foreign language proficiency
(Either English or Korean)
2-2. Supplementary Documents
1) The documents that can certify extra-curricular activities from an undergraduate school or a graduate school
2) The documents that can prove family economic situation, etc.
(All documents submitted should be originals. If original documents cannot be submitted, a copy of the original should be submitted with a seal affixed by the university, which the applicant will be or is enrolled in)
By signing here, I certify that the information that I have provided with this form is true and correct to the best of my knowledge and I fully understand that knowingly and willfully falsifying or concealing a material fact or using any false document in the submission of this form may result in the withdrawal of the scholarship.
. .2016
Applicant (Signature)
Director of International/Student Affairs’ office (Signature)
To Samsung Dream Scholarship Foundation

※Recommender’s Qualification

- Recommender should be a professor of theuniversity in Korea, where the applicant is supposed to go or belongs to.

- If the applicant is supposed to graduate high school this winter, recommender should be a teacher in the high school.

※Consent Form for Processing the Personal Information

- Scholarship candidate and recommender need to submit the attached <Consent Form for Processing the Personal Information (scholarship candidates/Recommender)>, and if you refuse to submit the consent form, you may be excluded from the scholarship program in such case.
Form 1-2>

Self-Introduction and Study Plan

Name / Nationality
1. Educational History
Date(dd/mm/yyyy) / Name of High School / GPA
~
Date(dd/mm/yyyy) / Name of University / Department/Major / Degree / GPA
~
~
~
2. Experiences ( Internship, etc.)
Date(dd/mm/yyyy) / Name of Facility / Job Title and Main Responsibilities.
~
~
3. Awards and Certifications
Date / Name of Award or Certification / Place of Issue
4. Voluntary activities
Date(dd/mm/yyyy) / Details / Place
~
~
5. Language Proficiency (including Korean)

*TOEFL, TOEIC, GRE score, Korean language test

Language / Name of test / Score / Date of Test
6. Clarity of Korean (Verbal) Expression □ Fluent □ Intermediate □ beginner
Clarity of Korean (Writing) Expression □ Fluent □ Intermediate □ beginner
Self-Introduction
* including financial situation, various activities like research, group activity, etc.
Reason for Applying to the KoreanUniversity
Plan of Study and Future Career
□ Study Plan in Korea(including Korean, Major)
□ Plan of Future Career and Community Service

(➫Please use more paper if needed)

Consent Form for Processing the Personal Information (Recommender)

Consent to Collection and Use of Personal Information (General Personal Information)

Personal Information for Mandatory Collection and Use

The following items of personal information of a reference provider must be provided for the purpose of selecting a scholarship student, providing a scholarship and receivingsupport from the Foundation. Such personal information shall be used until the purpose of collection and use, as set below, is achieved (subject to superseding applicable law). In the event that the candidate’s application is turned down, for the purpose of managing records regarding disqualified candidates, the candidate’s application shall be retained for one (1) year and other items managed by computer for five (5) years). You have the right to refuse consenting to the mandatory collection and use of your personal information, but the relevant candidate may be excluded from the scholarship program in such case.

Items to be Collected / Name, place to which a reference belongs, position and contact information (telephone number/e-mail address)
Purpose of Collection and Use / ‣Selection of scholarship students.
‣Internal use by the Foundation, including management of selected scholarship students after screening, payment of scholarship, management of records, assessment of continuous business promotion and statistical analysis, etc.
□I have fully understood the Foundation’s explanation regarding the collection and use of personal information and hereby consent thereto.

Personal Information for Optional Collection and Use

Certain of items personal information to be collected as listed above (e.g. name, gender, relationship with the candidate, etc.) may be used for the purpose of promoting the Foundation (such as publishing model reports, webzine and annual/research reports, etc.), which may be disclosed. You have the right to refuse the optional collection and use.

□I agree to the optional collection and use of personal information. □I disagree.

Consent to the Transfer of Personal Information to a Third Party (General Personal Information)

Personal Information for Mandatory Transfer

The following items of personal information must be provided to a third party for a scholarship candidate to be selected as a scholarship student, receive scholarship funding and receive support from the Foundation. You have the right to refuse the mandatory transfer, but the relevant scholarship candidate may be excluded from the scholarship program in such case.

Recipient Name / Recipient’s Purpose of Using the Personal Information / Items of Personal Information to be Transferred / Period of Retention and Use by Recipient
Candidate / Selection of scholarship students and performance of each program. / Share all of the items specified in the Personal Information for Mandatory Collection and Use as above. / Until the purpose of using the personal information is achieved
Person-in-charge of scholarship at recommendation joint university / Selection of scholarship students. / Same as above / Same as above
□I have fully understood the Foundation’s explanation on the transfer of personal information and hereby consent thereto.

I have carefully read and sufficiently understood the above information. Because I expressly consent on my own free will, I hereby affix my signature below.

. . 2016
Name (print):
Signature: ______

<Form 1-3

Letter of Recommendation

Name of Applicant / Nationality
Name of Recommender
Nationality / Employer
/Position
Tel No. / E-mail
Recommender Introduction
*Please include the explanation of the relationship to the applicant.
Opinions of Recommendation
. . 2016
Recommender : (Signature)