Guide to filling out the application form: Please fill out the application: typed and not hand-written.

. Do not modify by changing the font size or deleting parts of the application. Letter of Recommendation: 1) &P : 1) Loo! at attachment ' for reference.
2)

s! the recommender to fill out attachment "#$ seal the en%elope and sign the bac! flap of en%elope.

(f you can)t con%ert your score by using attachment '$ you must follow the instruction on the website www.wes.org *+,-.: /ou may ha%e to pay a fee)

0aculty$ Department and cademic 1a2or: 1) Loo! at 3451# 6yungsung 7ni%ersity &uideline8 attachment 1a!e sure to sign at the bottom of attachment "1 9 ": 1a!e sure each attachment " is at the top of the page 1a!e sure to add ;<# photo after completing the application form

/ou must fill out$ scan and send the application form by 1arch 1=th to sarahcho>!s.ac.!r

Schedule: pplication Period : ?urrent date @ 1ar.1= th *Documents scannedAemailed to 6yungsung 7ni%ersity) pplication Re%iew: 1ar.1'th @ 1ar.1Bth *Cy 6yungsung 7ni%ersity)

Phone (nter%iew: 1ar.45th @ 1ar.41st *Cy 6yungsung 7ni%ersity) nnouncement of selected 45 ?andidates: 1ar.4#th *Cy 6yungsung 7ni%ersity) pril 'th *1ust be recei%ed by pril 'th from the successful candidates)

,riginal Document D ; ?opies: 1ar.4#th @

ttachment "1

(Only for Applicants who apply for this program via a Designated University)

Korean Government Scholarship rogram (KGS ) Application !orm for Graduate Study
EPlease tic! *F ) a boG that applies to you.

"# ($nstitute of %ecommendation) *6orean 7ni%ersity) "# (&ype of %ecommendation) *&eneral) '# (Degree (ourse of Application) *1aster)s) H *Doctoral) )# (Desired !ield of Study) H *Iumanities and Jocial Jciences) *+atural Jciences and -echnology) H !" * rts and Physical .ducation) *# #$% &' (&O $K *( +( )* ) + , (Only for &O $K ,evel * and ,evel + holders) -&O $K ,evel * and + holders must start their studying from Sep ". /0")) H Jep 1$ 451#

-. ( ersonal Data)

Please read the form carefully. All applicants must complete all sections only by typing. /0 12*&i%en name) : /*0amily name) : H 1ale *0ull +ame) Kulia Ienderson Kulia Ienderson 0emale E +ame should be spelled the same as in the passport and in .nglish. 345 *Date of Cirth) 7 *?ountry) 89 *Passport) 4*1BL5) (ndonesia *+umber) XXXXXXXX *Date of (ssue) March 05 2013 :; *?ontact (nformation) Eonly applicant)s own <=> *(nformation concerning applicant)s most recent education) 5*5:) *4') 61* ge: ;;

Jingle
H 1arried

*Photo ;E#) Photo ; by #

*?itizenship)

(ndonesia

*Date of eGpiry) March 05 2018

ddress: Iome ddressA ?urrent ddressA Malid ddress -el. * DL4 15-'=:#-14;#) .-mail: ?urrentA Malid .-mail ddress <=?@* )A *+ame of pre%iously attended 7ni%.) F * cademic Degree recently awarded) C? 7ni%ersity BC7ADE *?ountryA?ity) G * cademic 1a2or) ?omputer Jcience ?ountryA?ity

Cachelor

H 1aster

$"> *Language Proficiency) Published papers$ if a%ailable*one or two) wards$ if a%ailable *one or two) KL * pplying 7ni%ersity)

<=FH'I *-itle of graduation dissertation$ if a%ailable) J$/*.nglish Proficiency) Nrite + if not a%ailable Nrite + if not a%ailable 0 *+ame of 7ni%.) 6yungsung 7ni%ersity

Nrite + if not a%ailable

-,.0L + (.L-J + Jcore : +

6orean Language Proficiency *only -,P(6)

Le%el: H1 H4 H; H# H: H= Jcore: +

M0 *0aculty)

0 *Department)

G * cademic 1a2or)

> * cademic ?areer)

N *Period) 455'@4511

OLoo! at 451# 6J7 OLoo! at 451# 6J7 OLoo! at 451# 6J7 &uideline for &uideline for the listP &uideline for the listP the listP +atural Jcience ?omputer Jcience ?omputer Jcience A0 BC7 GOP )*F *+ame of 7ni%.) *?ountry) * cademic 1a2or) *Diploma or Degree) C? 7ni%ersity ?ountry ?omputer Jcience C.Jc.

1st year 4nd year ;rd year #th year :th year /- Jchool TU WXV% /ear *-ransc (converted TV *&P ) ripts) score) -erm 1 4 ; 1 4 ; 1 4 ; 1 4 ; 1 4 ; /100 E1% QR Cachel- ;.:A ;.:A ;.:A ;.:A ;.:A ;.:A ;.:A ;.:A ;.:A ;.:A ;.:A ;.:A ;.:A ;.:A ;.:A ;.:A#.5 B5A155 or #.5 #.5 #.5 #.5 #.5 #.5 #.5 #.5 #.5 #.5 #.5 #.5 #.5 #.5 #.5 OLoo! at S attachment 'P *only A A A A A A A A A A A A A A terms 1aster A attende d) Y@ Z[ \]> N 0 Y ^ _C@` *,ccupation or *Period) *(nstitution or *Position) *,peration or Duty) Research ?areer) company) 455'455B C? 1iddle Jchool -eacher -eaching a #bcd a e fg !h i *Pre%ious Misits to 6orea) lm %n *Pre%ious Jcholarship wards Recei%ed from 6orean institutions) N *Period) + 0 *Jponsor) + mo* mount) *7JQAyear) * * 4*451#) pplicantRs +ame : Kulia Ienderson A ) A ) *5:) *signature Iand-written) %nN *Period) I*Purpose of Jtay)

j *?ity or Region)

aeRfgR!hk *,rganization ?oncerned)

5*54)

E &P *&rade Point %erage) must be con%erted on a maGimum scale of 155 points *con%erted points) E Jee ttachment ."' E 0ill out both the records of Cachelor)s 9 1aster)s in the case of those applying for Doctoral programs

ttachment "4 qr (Self $ntroduction) * Please type or print clearly within 1 page using blac in . (in !orean or in "nglish) (*10 points)

o /our course of life$ your %iew of life$ study bac!ground$ your hopes 9 wishes$ etc o /our education and wor! eGperience$ etc.$ in relation to the 6&JP program o /our moti%ations for applying for this program o Reason for study in 6orea

+, L,+&.R -I + ,+. P &.

ttachment "; @u (Study * Please type or print clearly within 1 page using blac in . (*10 points) &oal of study 9 Jtudy Plan

lan)

o #oal of study$ title or sub%ect of research$ and detailed study plan

&oal of study D study plan D future plan S no longer than one page

0uture Plan after Jtudy

o &uture plan in !orea or another country after study in !orea

&oal of study D study plan D future plan S no longer than one page

ttachment "#

,etter of %ecommendation
&o the applicant: Please fill in your name and the other reTuired information below. (n turn$ deli%er or email this form to the person who will write this letter. 1O&2: ReTuest your recommender to seal his or her letter of recommendation in an official en%elope and sign across the bac! flap upon completion. Recommendation letters that are not sealed and signed will not be accepted. (onfidential +ame of pplicant: *gi%en name) +ationality: Desired Degree Program: H 1aster)s Desired 1a2or: H Doctoral *family name)

&o the recommender: -he person named abo%e has applied for the U6orean &o%ernment Jcholarship Program). Ne as! for your assistance$ and would appreciate your fran! and candid appraisal of the applicant. * Please type or print clearly using black ink. 1. Iow long ha%e you !nown the applicant and in what relationshipV

Please assess the applicantRs Tualities in the e%aluation table gi%en below. Rate the applicant compared to other classmates who areAwere in the same school year with himAher. -ruly .Gcellent Mery &ood &ood Celow %erage .Gceptional ?lassification +A -op 4W -op 15W -op 4:W 1iddle :5W Lower 4:W cademic chie%ement 0uture cademic Potential (ntegrity ResponsibilityA(ndependence ?reati%ityA,riginality ?ommunication J!ills (nterpersonal s!ills Leadership 4. Nhat do you consider to be the applicant)s strengthsV

;. Nhat do you consider to be the applicant)s wea!nessesV

#. Iow well do you thin! the applicant has thought out plans for graduate studyV

:. Please comment on the applicant)s performance record$ potential$ or personal Tualities which you belie%e would be helpful in considering the applicant)s application for the proposed degree program.

Recommender)s +ame Recommender)s Jignature Position or -itle: 7ni%ersity *(nstitution): ddress:

Date

*zip-code: -el: 0aG:

lease return this form sealed in an official envelope and signed across the 3ac4 to the applicant# 5e greatly appreciate your timeliness regarding this letter for your recommendee#

ttachment ": 6Korean Government Scholarship rogram for Graduate Study7

ledge (cyc ) s an applicant for the 451# 36orean &o%ernment Jcholarship Program *6&JP) for &raduate Jtudy8$ ( pledge to abide by the following rules: *1) -o refrain from %iolation of uni%ersity regulations and to fulfill my obligations as a 6&JP scholar to the best of my ability. *4) -o beha%e in a manner appropriate to 6orean culture and society$ and not to participate in any form of political acti%ity *such as organizing a political party$ 2oining a political party$ attending political meetings$ publishing political articles and declarations$ organizing or participating in demonstrations of a political nature$ and so on). *;) -o accept responsibility for paying any debts incurred in 6orea *#) -o agree with +((.DRs decision concerning the graduate program and the 6orean language course *:) -o abide by all terms and regulations set by +((.D. *=) -o permit +((.D to use my personal information for the 6&JP. (f ( am pro%ed to ha%e %iolated any of the abo%e or to ha%e made a false statement in my application documents$ ( shall accept any resolution or penalty made by +((.D$ e%en when it mayAmight result in suspension$ re%ocation or withdrawal of my scholarship. ( was informed and fully understand that 6&JP scholars are not permitted to transfer schools for the entire duration of scholarship after confirming their host institution including 6orean language institution.

*451#). *54). *5:). pplicant)s +ame : Kulia Ienderson *signature Iand-written)

ttachment "=

pplicants are not reTuired to undergo an authorized medical eGam before passing the 4 nd Jelection with +((.DX howe%er$ all successful candidates must ta!e a comprehensi%e medical eGam when its) orientation *including an I(M and -CP. drug testEE$ etc) in accordance with the reTuirements of the 6orea (mmigration Jer%ice and the 6&JP. (f the results show that the applicant is unfit to study and li%e o%erseas more than ; years$ heAshe may be disTualified.
EE-he -CP. *tetrabromophenolphthalein ethyl ester) drug tests are for e%aluating past usage of stimulant drugs.

2%SO1A, 82D$(A, ASS2SS821&

&ender: 1

92$G9&

1=:

cm

52$G9& + /.J +,

=5 !g

Nhen and for what reason did you last consult a physicianV *Please eGplain in the ad2acent space.) Y7.J-(,+

(0 /.J$ PL. J. .<PL (+

Ia%e you e%er had an infectious disease that posed a ris! to public health *such as$ but not limited to$ tuberculosis$ 9$: and other S&Ds)V 1. allergiesV 4. high blood pressureV ;. diabetesV #. any type of IepatitisV

llergies: peanut$ dairy products

Ia%e you e%er suffered from or been treated for depression$ anGiety$ or any other mental or mood disorderV *(f you ha%e recei%ed treatment$ please eGplain and attach an official medical report.) Ia%e you e%er been addicted to alcoholV Ia%e you e%er abused any narcotic$ stimulant$ hallucinogen or other substance *whether legal or prohibited)V (f necessary$ are you prepared to undergo physical tests to %erify the answers gi%en in response to Tuestions and abo%eV Ia%e you been hospitalized in the last two *4) yearsV Ia%e you had any serious in2ury$ ailment or sic!ness in the last fi%e *:) yearsV Do you ha%e any %isual or hearing impairmentsV Do you ha%e any physical disabilitiesV Do you ha%e any cogniti%eAmental disabilitiesV re you ta!ing any prescribed medicationV re you on a special dietV ,n a%erage$ how many standard ser%ings of alcohol do you consume each wee!V

( drin! occasionally with my friends on the wee!end ( ha%e been hospitalized in the last 4 years due to typhoid

{|

ttachment "'

G A (onversion &a3le
)#0 Scale ;.B' @ #.5 ;.B4 @ ;.B= ;.LL @ ;.B1 ;.L# @ ;.L' ;.L5 @ ;.L; ;.': @ ;.'B ;.'1 @ ;.'# ;.=' @ ;.'5 ;.=4 @ ;.== ;.:L @ ;.=1 ;.#B @ ;.:' ;.#1 @ ;.#L ;.;4 @ ;.#5 ;.4# @ ;.;1 ;.1: @ ;.4; ;.5' @ ;.1# 4.BL @ ;.5= 4.B5 @ 4.B' 4.L1 @ 4.LB 4.'4 @ 4.L5 4.=# @ 4.'1 )#' Scale #.4= @ #.; #.44 @ #.4: #.1' @ #.41 #.14 @ #.1= #.5L @ #.11 #.5; @ #.5' ;.BL @ #.54 ;.B; @ ;.B' ;.LB @ ;.B4 ;.L# @ ;.LL ;.': @ ;.L; ;.=: @ ;.'# ;.:= @ ;.=# ;.#= @ ;.:: ;.;' @ ;.#: ;.4' @ ;.;= ;.1L @ ;.4= ;.5B @ ;.1' 4.BB @ ;.5L 4.B5 @ 4.BL 4.L5 @ 4.LB )#* Scale #.#= @ #.: #.#1 @ #.#: #.;= @ #.#5 #.;1 @ #.;: #.4= @ #.;5 #.41 @ #.4: #.1= @ #.45 #.11 @ #.1: #.5= @ #.15 #.51 @ #.5: ;.B1 @ #.55 ;.L1 @ ;.B5 ;.'1 @ ;.L5 ;.=1 @ ;.'5 ;.:1 @ ;.=5 ;.#1 @ ;.:5 ;.;1 @ ;.#5 ;.41 @ ;.;5 ;.11 @ ;.45 ;.51 @ ;.15 4.B1 @ ;.55 *#0 Scale #.B: @ :.55 #.B5 @ #.B# #.L# @ #.LB #.'B @ #.L; #.'; @ #.'L #.=L @ #.'4 #.=4 @ #.=' #.:' @ #.=1 #.:1 @ #.:= #.#: @ #.:5 #.;# @ #.## #.4; @ #.;; #.14 @ #.44 #.51 @ #.11 ;.B5 @ #.55 ;.'B @ ;.LB ;.=L @ ;.'L ;.:' @ ;.=' ;.#: @ ;.:= ;.;# @ ;.## ;.4; @ ;.;; "00 oints Scale 155 BB BL B' B= B: B# B; B4 B1 B5 LB LL L' L= L: L# L; L4 L1 L5

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