Teach and Learn in Korea (TaLK)
National Institute for International Education (NIIED)
Ministry of Education (MOE)
191 Jeongjail-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, (13557) Republic of Korea. Tel: +82.2.3668.1399. Site: www.talk.go.kr
TaLK Program Application (B)
★ Directions: Please answer questions 1-12 and place a check mark (✔) where appropriate.1. When was your last visit to a medical practitioner/doctor’s office?
1 year ago 2 years ago 3 years ago 4 years ago 5+ years ago
2. Please provide the nature of the visit and medical practitioner/doctor’s conclusion(s) in the space below.
3. Have you been hospitalized in the last two years?
※ If yes, please explain.NO / YES
4. Have you had any serious ailments, injuries or diseases in the past five years?
※ If yes, please explain.NO / YES
5. Have you ever been treated by a doctor for any mental, emotional or nervous disorders?
※ If yes, please explain and submit an original, sealed copy of a doctor’s note.NO / YES
6. Have you ever been treated for tuberculosis, epilepsy, renal or cardiac disease, diabetes or other serious illnesses?
※ If yes, please explain and submit an original, sealed copy of a doctor’s note.NO / YES
7. Do you have any piercings (aside from earlobe piercings) or tattoos?
※ If yes, please explain where and what it is (if applicable).NO / YES
8. Have you ever used any type of mind-altering substances?
※ If yes, please explain.NO / YES
9. Do you have any allergies?
※ If yes, please explain.NO / YES
10. Are you taking any prescribed medications?
※ If yes, please explain.NO / YES
11. Have you ever suffered from depression?
※ If yes, please explain in detail.NO / YES
12. Aside from the previously inquired, do you have any pre-existing medical conditions at the time of this application?
※ If yes, please explain.NO / YES
Note: Upon arrival in Korea, all TaLK scholars are to undergo a medical checkup, inclusive of drug and AIDS testing. If the scholars do not satisfy the health requirements, their scholarship will be rescinded.
I hereby confirm that all above statements are true and correct to the best of my knowledge. I understand that deliberately providing incorrect information will jeopardize my application to the TaLK program.
(Print Name)(Signature) / (Date)
* Please print out this application and hand sign your name with a pen before submitting it to your application office.
Letter of Pledge
Dear TaLK Program Director,
I, ______, certify that I have applied for the issuance of an Apostilled, national-level criminal record check (CRC) in the country of my residence. I am signing this letter to inform you that, due to special circumstances, I am unable to submit the criminal record check by the TaLK program application deadline; however, I promise to submit the Apostilled, national-level CRC as soon as I obtain it.
Furthermore, if the Apostilled, national-level CRC is not submitted or unsatisfactorily completed, I will not be eligible for the Exit Allowance. Finally, I understand that the Apostilled, national-level CRC is non-returnable once I have submitted it to the TaLK Office.
If I have been charged or convicted of any misdemeanor or felony in the past, I will provide a detailed explanation of the offense(s) and any and all allegations, including the date(s) and the location(s) of the event(s) in the space provided below. Depending on the nature and the severity of the offense(s), I understand that my scholarship offer may be revoked and I will not be able to participate in the program.
(Please write on a separate sheet of paper and attach to this form if the space provided below is not sufficient.)
I certify that the information provided, including attachments to this form, is true and correct. I agree to notify the TaLK Office of any change(s) in circumstance that would require disclosure hereunder. Should the information that I provide be false or incorrect, I will relinquish my scholarship.
Sincerely,
(Print Name)(Signature) / (Date)
* Please print out this application and hand sign your name with a pen before submitting it to your application office.
TaLK Program Application (B)
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