DUKSUNG WOMEN’S UNIVERSITY

2017 Discover korea at duksung

international summer school Application

Note: Please ensure to type correctly and return this form by April 30th, 2016.

1. PERSONAL INFORMATION

Full Name

First name Middle name Last/family name

Date of birth Gender ¨ M ¨ F

Day Month Year

Enter name & date of birth exactly as it appears on your passport.

Country of Citizenship

E-mail Address

Predominant language spoken in your home

Indicate your fluency of the foreign languages listed below.

KOREAN ¨ fluent ¨ good ¨ a little ¨ none

ENGLISH ¨ fluent ¨ good ¨ a little ¨ none

OTHERS ( ) ¨ fluent ¨ good ¨ a little ¨ none

Korean Language Course Level Preference: ¨ Beginner (I do not know any Korean)

¨ Beginner Intermediate (I know some Korean)

Emergency Contact Information

Name Relationship

Address

Telephone Mobile Phone Email

Dietary Preferences ¨ none ¨ Vegetarian ¨ Muslim ¨ Other ( )

Medical Conditions

Allergies

Other remarks about your health condition

2. EDUCATIONAL INFORMATION

Name of Institution you’re currently enrolled at

Academic Field:

Major Name of Department & College

Academic Level: ¨ Freshman ¨ Sophomore ¨ Junior ¨ Senior

Advisor’s Contact Information (at your home institution)

Name Position Department

Address

Telephone Email

3. TRAVELING INFORMATION – You could summit this information later on through email() no later than June 15th

Arrival at Incheon International Airport

Date and Time Airline and Flight Number

Departing City Country

Pick-up Service 2017 July 3rd (Mon) 13:00 ¨ 18:00 ¨ I do not need the pick-up service.

Departure at Incheon International Airport

Date and Time Airline and Flight Number

Departing City Country

Drop-off Service 2017 July 21st (Fri) ¨ 08:00 ¨ 13:00 ¨ I do not need the drop-off service.

4. ACCOMODATION INFORMATION

Check-in Date Check-out Date

Roommate Preference:

5. PARTICIPATION CERTIFICATION

Student Certification “By signing this form I certify that all the information I have provided is true, and I confirm to participate in the 2016 Discover Korea At Duksung program.”

Name Signature Date

Office of International National Affairs, Duksung Women’s University

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