Application for Exchange Student Program

Dong-A University
Application for Exchange Student
Program
Personal Information
1.
Name in Full (성명)
-InR om anBlockC apital& K anji
In Roman Block Capital
Family Name(성)
Given Name(명)
Family Name(성)
Given Name(명)
In Kanji
2.
Nationality (국적)
3.
Country of Birth (출생지)
4.
Date of Birth (생년월일)
5.
Passport Number(여권번호)
6.
Present Address(현주소)
6. Sex (성별)
M/
D/
Y
Male (남)
Female(여)
(Street Address)
(City and Country)
7.
Telephone (전화)
9.
E-mail (이메일)
(Postal Code)
8. Fax (팩스)
10. Person to be notified in case of emergency
Name (이름)
(비상연락처)
Relationship (본인과의 관계)
Address (주소)
(Street
Address)
(City and Country)
Telephone (전화)
(Postal Code)
Dong-A University
Academic Information
1.
Home Institution at Present (소속대학)
2.
Department (학과)
4.
Current year of study(학년)
5.
Expected Graduation Date (졸업예정일)
3. Major Field (전공)
M/
Y
Study at Dong-A
1.
Academic Year (입학연도)
2.
Duration of Study (수학기간)
3.
Please choose the programs you wish to attend for the first semester.(유학과정 선택)
4.
□ Spring Semester
□ One Year
□ Fall Semester
□ One Semester
□
Undergraduate Program (학부과정)
□
Graduate Program (대학원과정)
□
Undergraduate Program & Korean Language Program (학부과정 & 한국어강좌 )
Major at Dong-A(소속전공)
*　本校での希望選考を交換学生案内の情報をもとに作成お願いします。
*　希望した選考が学校に事情により変更になる可能性があります。
*　他の学部の授業を受ける場合には担当教員の相談の上、承認を取得ご受講することができますので
所属学科のほど正確に作成お願いします。
5.
Accommodation (숙소)
On Seung-Hak(Hadan) Campus Hanlim Dormitory(한림생활관)
*　2 人一室　・　交換学生情報をご覧ください。
Language
1.
Have you ever studied Korean before? (한국어 학습유무)
□
2.
Proficiency
Yes, I have
□ No, I haven’t
Korean Language Experience (한국어 학습경력)
Dong-A University
Name of Institute
Period of Study
*独学でもかまいませんので学習機関を正確に作成お願いします。
3.
Korean Proficiency (한국어 능력)
Category
Excellent
Good
Fair
Poor
Good
Fair
Poor
Listening
Speaking
Reading
Writing
4.
Other Languages (기타 외국어)
Language
Excellent
*　韓国語講座は初級は寮の近くのスンハック、中級・高級は寮から離れている（バス 20 分）の
ブミン・キャンパスでの授業になります。
*　現地の事情により語学堂の場所が変更する可能性があります。
５.　語学認定証（ある場合だけ作成お願いします。）
認定を受けた機関
グレード
*　認定書がある場合、作成後、認定書のコピーも別途添付お願いします。
*　資格により選定は行いません。
Dong-A University
Certification
by Applicant
I certify that the information provided on this form is accurate and true.
Signature (서명)
Date (날짜)
M/
D/
* Required Application Documents (제출서류)
- Completed Application Form (입학지원서)
- Certificate of Enrollment (재학증명서)
- Official Transcript of Your University (성적증명서)
- Copy of Passport (여권사본)
- 4 Photos sized 3cm×4cm (증명사진 4 장/背景が白いもの)
- Medical Check-up List(건강진단서/健康診断書（結核・ B 型肝炎の有無がわかる診断書）
Y

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