JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
STUDENT APPLICATION
* Indicates required question
참가프로그램
SEP 초3~중2 HDP 중3~고3
SEP
HDP
Clear selection
Grade you wish to start in U.S?
Choose
3
4
5
6
7
8
9
10
11
12
FAMILY INFORMATION
Home Phone
Your answer
Home Address
Your answer
STUDENT
Passport Name-영문이름
띄어쓰기에 유의하세요 예)HONG GILDONG 홍길동
Your answer
한글이름
*
Your answer
Nickname
Your answer
Gender
*
Male
Female
Date of Birth
*
MM
/
DD
/
YYYY
Place of Birth
시(市)까지 써주세요 예)Gyeonggi-do Seongnam-si
Your answer
Cell Phone
Your answer
E-Mail(Student)
Your answer
Grade in Korea at present
Choose
3rd
4th
5th
6th
7th / 중1
8th / 중2
9th / 중3
10th / 고1
11th / 고2
Name of School
Your answer
Religion
Choose
Catholic
Christian
Buddism
None
Religion Organization
Your answer
FATHER
Passport Name(Father)
Your answer
한글성명(Father)
Your answer
Nickname(Father)
Your answer
Date of Birth(Father)
MM
/
DD
/
YYYY
Cell Phone(Father)
Your answer
E-mail (Father)
Your answer
Occupation(Father)
Your answer
Company & Position(Father)
Your answer
Religion(Father)
Choose
Catholic
Christian
Buddism
None
Religion Organization(Father)
Your answer
MOTHER
Passport Name(Mother)
Your answer
한글성명(Mother)
Your answer
Nickname(Mother)
Your answer
Date of Birth(Mother)
MM
/
DD
/
YYYY
Cell Phone(Mother)
Your answer
E-mail (Mother)
Your answer
Occupation(Mother)
Your answer
Company & Position(Mother)
Your answer
Religion(Mother)
Choose
Catholic
Christian
Buddism
None
Religion Organization(Mother)
Your answer
OTHER FAMILY MEMBERS
같이 사는 형제, 조부모등 여러사람이 있을경우에는 추가기입에 써주시기 바랍니다.
Relationship
Your answer
Name
Your answer
Date of Birth(Members)
MM
/
DD
/
YYYY
Occupation(Members)
Your answer
Add(Other Members)
Your answer
HONORS AND AWARDS
Honors and Awards
Your answer
Description(Honors and Awards)
Your answer
Date(Honors and Awards)
MM
/
DD
/
YYYY
Type
Academic
Other
Clear selection
Add(Honors and Awards)
Your answer
PERSONALITY
How would you describe the personality type of the student? (Select one from each number)
1
Introverted-quiet energy
Extroverted-high energy
Clear selection
2
Reserved & contemplative
Outgoing & enthusiastic
Clear selection
3
Detailed & specific
Look at big picture & possibilities
Clear selection
4
Practical (see what is)
Idealistic (see what could be)
Clear selection
5
Logical & objective
Warm & compassionately
Clear selection
6
Honest & direct
Tactful & diplomatic
Clear selection
7
Conventional & orderly
Flexible & adaptive
Clear selection
8
Structured & planned
Open & spontaneous
Clear selection
9
Authoritative & disciplined
Permissive & easy going
Clear selection
10
Clean & organized
Not too tidy & relaxed
Clear selection
11
Active & busy
Laid-back & relaxed
Clear selection
Please tell us about the student's personality that your want to share with us.
성격적인 부분에 대해 더 말씀하고 싶은 사항을 적어주세요
Your answer
HEALTH INFORMATION
Does the student have any allergies or medical condition?
NO
YES
Clear selection
If he/she does, please describe it in detail (especially the signs and symptoms of the condition)
Your answer
Is he/she on medication?
NO
YES
Clear selection
If so, please describe.
Your answer
Next
Page 1 of 9
Clear form
Never submit passwords through Google Forms.
This form was created inside of KOAM EDUCATION ALLIANCE.
Report Abuse
Forms
