Application Form. Recent Color Photo. Date of Birth (YYYY/MM/DD). Primary/Native Language. Blood Type (for medical emergencies_. Home Contact Information. Physical Address. Dietary Restrictions. Food/Medication Allergies (please detail, including conditio

Application Form

Please fill in the requested details correctly, and write ‘NO’ if there is no applicable choice or detail(s) for you.

PART A: PERSONAL INFORMATION

Legal Name(As indicated in your passport)

Korean Name(if available)

qMale

qFemale

Recent Color Photo

(Photo should be less than 6 months old, and be 3.5x4.5cm)

Date of Birth (YYYY/MM/DD)

Primary/Native Language

Blood Type (for medical emergencies_

q A+ qA- qB+ qB- qAB+ qAB- qO+ qO- qDon’t Know

Home Contact Information

Physical Address

Email Address

Phone (Country Code – Area Code – Number)

Cell (Country Code – Area Code – Number)

PART B: ADDITIONAL INFORMATION
Passport Number (Write ‘applying’ if it is being processed’)	Passport Expiration Date (YYYY/MM/DD)

Dietary Restrictions

Food/Medication Allergies (please detail, including condition name, symptoms, reactions, etc.

PART C: ACADEMIC & LANGUAGE INFORMATION
Academic Institution(including Department)					Your Program Name/Major(s)

Institution Location(Province/State and Country)

Language Skills/Ability	Korean		English			Other ( )
	q Advanced q Intermediate q Basic		q Advanced q Intermediate q Basic qNone			q Advanced q Intermediate q Basic qNone
Achieved TOPIK Level*	q TOPIK 1	q TOPIK 3	q TOPIK 5	Achieved TOPIK Score*
	q TOPIK 2	q TOPIK 4	q TOPIK 6

* The TOPIK Level and Score is applicable to your most recent results achieved after March 1^st 2018.

PART D: EXPERIENCE AND SHORT ESSAY

Please detail your experience in learning Korean, including when you started, where, and how.

Have you ever been to Korea? If so, please detail below. (Suggestions: How long ago, purpose of visit, etc.)

What do you want to do and/or learn through our Invitation Program?

Is there anything else you would like us to know?

PART E: CONFIRMATION OF ACCURACY OF DETAILS
With my name and signature provided below, I hereby affirm that all information provided on this document is both complete and true. I understand that if discrepancies are found in the information that cannot be verified, that my consideration for the 2020 Invitation Program for Distinguished TOPIK Achievers may be disqualified.
Printed Name	Signature	Date