YEUNGJIN-SAMSUNG SCHOLARSHIP PROGRAM 2010
Application Form
Please fill out the Application Form and submit it together with your Personal Statement
and Study Plan. For further instructions how to write personal statement and study plan,
please read carefully the program details.
Personal Information (Part I)
<General Information>
Full Name:
First Name:
Last Name:
Date of Birth (yyyy-mm-dd):
Nationality:
Religion:
Family [※ Mark "O" in ( )]: Grandfather( ), Grandmother( ),
Father( ), Mother( ), Brother ( ), Sister( )
※ Please insert your clear
passport photo here. You can
erase this after you insert it.
Address:
Home phone:
Cell phone:
Email:
Skype ID:
<Educational Background>
Name of School:
Period (From yyyy-mm-dd – To yyyy-mm-dd):
Major:
Name of degree/diploma:
Graduation Date (Only for graduates):
Expected date of graduation (Only of undergraduates):
Any remarks:
Name of School:
Period (From yyyy-mm-dd – To yyyy-mm-dd):
Major:
Name of degree/diploma:
Graduation Date (Only for graduates):
Expected date of graduation (Only of undergraduates):
Any remarks:
Name of School:
Period (From yyyy-mm-dd – To yyyy-mm-dd):
Major:
Name of degree/diploma:
Graduation Date (Only for graduates):
Expected date of graduation (Only of undergraduates):
Any remarks:
*For Edcuational Background, please add more if necessary in the same question format as above.
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YEUNGJIN-SAMSUNG SCHOLARSHIP PROGRAM 2010
<Work Experience> * Detailed description for each one should be provided in Part II.
Name of organization:
Period (From yyyy-mm-dd – To yyyy-mm-dd):
Region (City and Country):
Position:
Responsibilities:
Name of organization:
Period (From yyyy-mm-dd – To yyyy-mm-dd):
Region (City and Country):
Position:
Responsibilities:
Name of organization:
Period (From yyyy-mm-dd – To yyyy-mm-dd):
Region (City and Country):
Position:
Responsibilities:
*For Work Experience, please add more if necessary in the same question format as above.
<Volunteer work, team projects>
Name of organization:
Period (From yyyy-mm-dd – To yyyy-mm-dd):
Position:
Responsibilities:
Name of organization:
Period (From yyyy-mm-dd – To yyyy-mm-dd):
Position:
Responsibilities:
Name of organization:
Period (From yyyy-mm-dd – To yyyy-mm-dd):
Position:
Responsibilities:
*For Work Experience, please add more if necessary in the same question format as above.
<License or awards>
Acquired date (yyyy-mm-dd):
Name of the license:
Host Organization:
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YEUNGJIN-SAMSUNG SCHOLARSHIP PROGRAM 2010
Acquired date (yyyy-mm-dd):
Name of the license:
Host Organization:
Acquired date (yyyy-mm-dd):
Name of the license:
Host Organization:
*For License, please add more if necessary in the same question format as above.
<Training/Seminar>
Period (From yyyy-mm-dd – To yyyy-mm-dd):
Name of training/seminar
Host organization
Period (From yyyy-mm-dd – To yyyy-mm-dd):
Name of training/seminar
Host organization
Period (From yyyy-mm-dd – To yyyy-mm-dd):
Name of training/seminar
Host organization
*For Training/Seminar, please add more if necessary in the same question format as above.
<Any other remarks>
(Please mention anything you would like to add in addition to what you mentioned above.)
I hereby pledge that abovementioned matters are true.
Date(yyyy-mm-dd) :
Full Name:
Signature:
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YEUNGJIN-SAMSUNG SCHOLARSHIP PROGRAM 2010
Self-introduction (Part II)
Full Name:
Personality (strong points/ weak points)
Strong points
Weak points:
Specialties (Computer skills, foreign language skills)
Example
- French: speaking(intermediate), listening(intermediate), reading(advanced), writing(beginner)
- Microsoft Office(Powerpoint, Word, Excel)
Hobbies/ Other skills
Example
-Playing piano, plaing drum
-Singing & Jazz dance
Reasons for application for this program
(ex. to have special experience abroad... etc.)
Expectations
(Please write what you expect while you will be studying in Korea.)
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YEUNGJIN-SAMSUNG SCHOLARSHIP PROGRAM 2010
Description of work experience
(Please mention name of the organization, location, short introduction of the organization, and one’s
own responsibilities for each work experience that you mentioned in Part I. Your main responsibilities,
what you learned from work and why you stopped working should be described in detail.)
1. Please write here for item one.
2. Please write here for item two.
3. Please write here for item three.
Reference(s)
Full name:
Organization/Position:
Your relationship to this person:
Phone number:
Email:
Full name:
Organization/Position:
Your relationship to this person:
Phone number:
Email:
I hereby pledge that abovementioned statements are true.
Date(yyyy-mm-dd) :
Full Name:
Signature:
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