(SAMPLE) ONLINE
APPLICATION FORM
FOR ADMISSION
APPLICATION
NUMBER
Will be given by KAIST
International Undergraduate
This form is a sample, and you will fill out the form online ( https:/apply.kaist.ac.kr/InterApply ) when the
application window is open.
1. Applicant Information
Name in English
(as appeared in
passport)
your
(Last/First)
TSA-BOU NGALIA ATEMBE
CAMEROONIAN
Nationality
Date of Birth
2005/04/28
Acquisition Date of
Citizenship
2021/04/08
□
Gender
Photo
(3cm * 4cm)
Only for
jpg,bmp,png
MALE
Place of
Birth
LEWOH
□ By Feb 28, 2018
Already graduated
Expected High School
Graduation Date
□ Within March 1 ~ August 31, 2018
KAIST Enrollment
□ Other (yyyy/mm/dd)
□ 202x Spring (Only for Early Track)
□ 202x Fall (For Early, Regular, and Late Track)
Contact Information
Postal Address
E-mail Address
Telephone
Mobile Phone
Guardian’s Information
Name
Relationship
Postal Address
Telephone
BUEA,BOMAKA
ngaliaprodencia0@gmail.com
+237674512170
+237674512170
NKONGDEM BERTRAND
BROTHER
CANADA,SASKATOON
+1306 220 7003
Fields of Interest* (Click the box of departments or areas of study that you wish to pursue at KAIST)
□ Physics
□ Mathematical Sciences
□ Chemistry
□ Biological Sciences
□ Mechanical Engineering
□ Civil & Environmental
Engineering
□ Chemical & Biomolecular
Engineering
□ Aerospace Engineering
□ Electrical Engineering
□ Bio & Brain Engineering
□ Industrial Design
□ Materials Science &
Engineering
□ Nuclear & Quantum
Engineering
□ Computer Science
□ Industrial & Systems
Engineering
□ Business & Technology
Management
□ Interdisciplinary Track
* You will hold an undeclared major for the first year at KAIST, and you will choose whichever major you want after your freshman year
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2. High School
The application requires one letter of recommendation: one from your academic advisor/homeroom teacher or
math/science teacher. Please provide information of your recommender below. (Academic Advisor / Homeroom
Teacher / Math or Science Teacher)
High School Name
RAINBOW BILINGUAL COLLEGE DSCHANG
High School
Postal Address
Zip code
Official Internet Website
Country CAMEROON
DSCHANG
rainbowbilingualschooldschang.org
(Expected) Graduation Date
Recommender
Information
City
237
2023/05
RAINBOW BILINGUAL COLLEGE
DSCHANG
Name
School Name
Position
Postal Address
City
Cameroon
Country
dschang
E-mail
Address
Telephone
Number
3. Academics
List the names and other necessary information of the schools you have attended or are attending in chronological
order (Up to 8 schools).
Education
(Elementary School/
Middle School/
High School/
College/University)
Date of
Entrance ~
Graduation
(yyyy/mm)
(2007/09-2008/05)
Elementary School
Location
Name
Enrolled Period
Country
Nursery School Alou
Cameroon
Cameroon
(2008/09-2010/05
Elementary School
Nursery School Alou
(2010/09-2016/05
Elementary School
Catholic School Foto
(2016/09-2017/05
Middle School
(2017/09-2018/05
Middle School
(2018/09-2020/05
Middle School
GBHS Dschang
(2020/09-2022/05
High School
GBHS Dschang
(2022/09-2023/05
High school
GBHS Alou
College Tiako Melong
Alou
Alou
One year
Two Years
Alou
Six years
Cameroon
Alou
1 year
Cameroon
melong
1 year
Cameroon
Dschang
2 years
Dschang
2years
Cameroon
Cameroon
RAINBOW COLLEGE
City
Cameroon
Has your schooling been interrupted during the last six years?  Yes
If yes, when was it? From
to
(2021/09)
(2022/05)
Dschang
1 years
 No
And, why? ____Sickness______________________________________________________________________________________
4. English Proficiency Test
PBT
TOEFL
CBT
TOEFL
IBT
TOEFL
TEPS
IELTS
Score/Level
Test Date
TOEIC
Check here if your native
language is English or studied
in English Medium high school
□
2
(2023/09/09)
5. Extracurricular Activity
Please list your principal extracurricular, volunteer, or community activities in the order of significance to you. (Up
to 5 items)
Period
Detailed Information on the activity,
(yyyy/mm)
Activity
such
as hours you spent and your role
To
from
2017 2018
/
2019 / 2020
2021 /2022
/
/
/
/
/
/
/
FOOTBALL
Spends 6 to 8 hours a week on training and matches
FOOTBALL
Spends 6 to 8 hours a week on training and matches
FOOTBALL
Spends 6 to 8 hours a week on training and matches
6. Work Experience
Please list your principal work experience and paid jobs in the order of significance to you. (Up to 3 items)
Period
(yyyy/mm)
Name & Location of Workplace
Position
Type of Work
from
To
/
/
/
/
/
/
7. Scholastic Aptitude Tests ※ Please click V on online reporting checkboxes.
If you have taken any college scholastic aptitude test, please fill out the following accordingly. The official score
report of each test should also be sent to KAIST by the document submission deadline.
Submission Method
Test Date
(yyyy/mm)
SAT
Reasoning
Test
Reading&W
riting
(Critical
Reading)
Math
Composite
/
Test Date
(yyyy/mm)
Essa
y
(Wri
ting)
//
Subject
Score
Test Date
(yyyy/mm)
/
/
/
/
Subj
ect
Score
Subj
ect
Score
Submission Method
Test Date
(yyyy/mm)
AP
Subject
Score
Test Date
(yyyy/mm)
/
/
/
/
/
/
3
Submission Method
Test Date
(yyyy/mm)
IB
Subject
Level
Test Date
(yyyy/mm)
Score
/
/
/
/
/
/
Subj
ect
Lev
el
Score
Submission Method
Test Date
(yyyy/mm)
GCE- A Level
Subject
Score
Test Date
(yyyy/mm)
/
/
/
/
/
/
Subject
Score
Submission Method
ACT Test
Test Date
(yyyy/mm)
English
Math
Reading
Science
Comp
osite
Writing
/
International
Olympiad
Or
National Exam
Test Date
(yyyy/mm)
(Univ. Entrance Exam
/ H.S Leaving Exam)
Score
(earned/
full mark)
Name of the Test
/
/
/
8. Honors and Awards (Up to 5)
Please list the honors or awards you have obtained during your secondary and tertiary education. Each item
below will be considered valid only when respective testimonial/evidence is submitted. Those of school or local
level will not be given credit. Please list them in order of importance.
Date
Level of Recognition
No
Title
Rank
(National/International)
(yyyy/mm)
/
Issuing Institution
1
Name:
Website:
Email:
Explanation of the Award/Honor (up to 30 words):
2
/
Issuing Institution
4
Name:
Website:
Email:
Explanation of the Award/Honor (up to 30 words):
/
Issuing Institution
3
Name:
Website:
Email:
Explanation of the Award/Honor (up to 30 words):
/
Issuing Institution
4
Name:
Website:
Email:
Explanation of the Award/Honor (up to 30 words):
/
Issuing Institution
5
Name:
Explanation of the Award/Honor (up to 30 words):
Website:
Email:
9. Writing
KAIST seeks to foster talent who possess a love for challenges, creativity, and a caring spirit.
Please complete the Personal Statement with consideration of the above qualities.
Q1. Please describe your dream and the efforts you have made so far to achieve it and your future plan for it.
(within 2000 characters/300words)
※ Please include your reason(s) for choosing KAIST in order to achieve your dream and the hardships that you
expect to encounter in the process.
Q2. Please write the personal statement with a focus on what you learned from and felt during
curricular and/or extracurricular activities (up to three) to which you attached meaning and devoted
yourself in high school.(within 1500 characters/200words)
Q3. Please cite any cases in which you thought and/or made attempts in ways different from those of
others and describe how such ideas and/or attempts affected you and people around you. (within
1500 characters/200words)
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Q4. Please cite any cases in which you practiced consideration, sharing, cooperation, and/or conflict
management and describe what you learned from and felt during the
process(es). (within 1500 characters/200words)
Q5. Please write if there is any other information you would like to tell us regarding your
family/social background or difficulties you had to overcome in the past. (within 1000
characters/150words)
※ Important Note
1. The personal statement must be written by the applicant himself or herself and must frankly describe the
applicant’s abilities, characteristics, experiences, etc. based on facts.
2. When requested to confirm the factuality of the contents described in the personal statement, the applicant
must cooperate actively.
3.
Similarity searches are conducted on the submitted personal statement in order to verify the presence of
plagiarism, proxy authorship, inclusion of falsehood, and/or any other acts of dishonesty. If and when such
facts are discovered, the applicant will be disqualified and may have his or her admission revoked even after
being accepted.
I certify that all information provided in my application is accurate, complete, and honestly
presented. I understand that any omission, inaccurate information or misrepresentation
herein may result in cancellation of my admission to KAIST.
I hereby agree that the ‘Recommendation Letter’ remains strictly undisclosed.
_______________________________________
Applicant’s Signature
_______________________________________
Date (yyyy/mm/dd)
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