2024 GKS-U Application Forms 13 Oct

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2024 GLOBAL KOREA SCHOLARSHIP

Undergraduate Degree Program

Application Checklist

Embassy Track (공관전형) ✘ University Track (대학전형)


Name of Institution Receiving Application (공관/대학명): _______________Dong-A University__

Name of Applicant(성명) : (Family, Given, Middle) Ahtasum Nafis

Country of Citizenship(국가) : Bangladesh

Checklist (Submission of Documents) Please check (√) in the appropriate box.

Type No. Application Documents Note Check


1 (form 1) Application Form
2 (form 2) Personal Statement
Documents to 3 (form 3) Study Plan
Required
complete 4 (form 4) ONE letter of Recommendation
5 (form 5) GKS Applicant Agreement
6 (form 6) Personal Medical Assessment
7 Proof of citizenship (applicant and parents) and proof of family relationship
8 High School Graduation Certificate (or certificate of expected graduation) Required

Required 9 Academic transcript of high school curriculum


certificates Graduation certicate (or certificate of expected graduation) of associate
10
degree program
*Submit with
11 Academic transcript of associate degree Required for
apostille/consular-
confirmation
relevant
12 Proof of Overseas Korean Document
applicants
13 Proof of Korean Citizenship Renunciation Document
14 Proof of Korean War Veteran's Descendant
15 Score report of valid TOPIK (original) or English Proficiency Test (copy) Optional

Other 16 Copy of awards and other certificates, etc. (copy) Optional


documents Required for
17 Applicant's Passport (copy) relevant
applicants
FORM 1. 2024 Global Korea Scholarship Application

Items marked in the red box are required for all applicants.

Click the box( ) to check or uncheck.

1. Application Track 지원 전형
Embassy Track 공관전형 ✘ University Track 대학전형
2. Type of Application 지원 프로그램
[Embassy Track] General 일반 Overseas Koreans 재외동포
[University Track] UIC 산학협력과정 ✘ Regional University 지방대 Associate Degree 전문학사
3. Degree Program to Apply 지원 학위 과정
✘ Bachelor’s Degree 학사 Associate Degree 전문학사
4. Desired Field of Study (Division) 희망계열 (You can select multiple fields) * Please refer to the “University Information” file

Liberal Arts 인문 Social Science 사회 Natural Science 자연과학


Arts and Sports 예체능 Education 교육 Medicine 의학
✘ Engineering 공학 Artificial Intelligence (AI) 인공지능(AI)

Please complete the form below. It must be typed in English ONLY. Delete the examples when typing your own information.
5. Information of the Applicant 지원자 정보
Family Name 성 Ahtasum

Full Name Given Name 이름 Nafis


Photo
성명
Middle Name 중간 이름
Size: 3cm x 4 cm
*Please write your full name as indicated on your passport or official documents 증명사진
Date of Birth (YYYY-MM-DD)
2000-07-02 Gender 성별 ✘ Male Female
생년월일

Country of Citizenship 국적 Bangladesh

Korean Citizenship Applicant’s Parent(s) Yes ✘ No


Applicant Yes ✘ No
한국국적 여부 (if any one of your parents has Korean Citizenship, check ‘YES’)

Address Mohammadpur, Tanore, Rajshahi.

Contact Information Phone (start with the country code) +8801521120518; +8801875775123
지원자 본인 연락처
*Must be applicant’s
E-mail [email protected]

6. Language Abilities 어학 능력

1 2 3 4 5 6급 English Proficiency Test TOEIC e.g., 850


TOPIK Level
Scores
한국어능력시험 성적
Test Held/Test Date (회차/ 영어공인시험 성적 TOEFL
시험일)
e.g., 78th, 2021-10-16 ✘ IELTS 7.00

7. Level of Education 학력 정보
High School Program (Required for all applicants)

High School Name 학교명 Rajshahi College

Location (Country) 소재국 Bangladesh


High School Period of Attendance
고등학교 2015-2017 (11th -12th grade)
재학 기간
Date of graduation Date indicated in your graduation certificate
졸업일 (YYYY-MM-DD) 2017-07-23
Date of expected graduation Date indicated in your certificate of expected graduation (required for relevant applicants)
졸업예정일 (YYYY-MM-DD)

Associate Degree (Required for Applicants who have Associate Degree)

University Name 학교명

Location (Country) 소재국

University/Institute Major 전공
전문학사 기관
Date of graduation Date indicated in your graduation certificate
졸업일 (YYYY-MM-DD)
Degree awarded date Date indicated in your diploma. It may or may not be the same as your graduation date.
학위 수여일 (YYYY-MM-DD)
Date of expected graduation Date indicated in your certificate of expected graduation (required for relevant applicants)
졸업예정일 (YYYY-MM-DD)

Have you ever earned a bachelor’s degree in the past? Yes ✘ No

8. Information on Academic Transcript / Grades 성적 정보

CGPA Score Percentile


최종평균평점 백분율 환산 점수
If your transcript does not have score percentile,
Cumulative GPA (CGPA) CGPA indicated on your original transcript refer to Appendix A. GPA Conversion Table to
of Previous program* 5.00/5.00 convert your CGPA into 100 points scale
직전 학위
전체평균평점 Converted CGPA (in 4.0, 4.3, 4.5, 5.0, or 100 scale only)

5.00/5.00 100/100
※ MUST be confirmed by the school/university ✘ Yes No
* If you have (or are expected to receive) an associate degree, please fill in your grades achieved from the associate degree program
GPA indicated on your original academic transcript 성적표 상 표기된 학기별/학년별 평점
* If needed, you may modify columns
Year 1st year 2nd year 3rd year 4th year

Semester
1 2 1 2 1 2 1 2
/Term
Grades
or Rank 3.95/5.0 / / / / / / /

※ If your academic transcript only indicates CGPA and does not provide GPA per semester, then you may leave this table empty.
9. Choice of University and Department 지원대학 및 학과
Other (i.e., major)
Field of Study (Division)
University 대학 Department 학과 (optional)
계열 기타(세부전공 등)
choose universities ONLY from Type B
Choice 1 e.g., Liberal Arts
choose universities among Type A or B
Embassy Choice 2
Track
choose a university among Type A or B
Choice 3

choose universities among Type A or B


✘ University Track Dong-A University Engineering Electronic Engineering

※ Attention! Please refer to “University Information” file posted with the application guidelines. If necessary, copy and paste.
 Embassy Track applicants can choose up to THREE different universities in any order of preference. However, Choice 1 must be
from Type B universities.
 University Track applicants must choose ONE university.
 Field of Study (Division) and Department should match the information provided in the “University Information” file.

10. Previous Visits to Korea or Currently Residing in Korea (if any) 한국 방문 혹은 체류 정보(해당자만 기재)

Period Purpose of Stay City/Region Affiliated Organization (if any) Visa Type
방문/체류 기간 방문/체류 목적 도시/지역 방문/체류 기관(해당자만) 비자 종류
e.g., Korean language
e.g., 2020.July~August e.g., Seoul e.g., GKS University e.g., D-4
study

※ Please put your visa type especially when you are currently residing in Korea.

11. Previously Received Scholarship from Korean Government or Institutions (if any) 한국 장학금 수혜사실(해당자만)

Period Name of the Scholarship Sponsor


수혜 기간 장학금명 지원 기관
e.g., GKS Non-degree program for foreign exchange
e.g., NIIED
students

THE ANSWERS I HAVE GIVEN ABOVE ARE TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE. IF MY

ANSWERS CONTAIN ANY KIND OF FALSEHOOD, I WILL TAKE ANY LEGAL RESPONSIBILITY.

2023-10-13 Ahtasum Nafis

Date (yyyy-mm-dd) Applicant’s Full Name Signature


FORM 2. PERSONAL STATEMENT
“Ever tried. Ever failed. No matter. Try Again. Fail again. Fail better.” Samuel Beckett may have stated the quote
for me.

Growing up in dire circumstances, I faced life's challenges from a young age. At that time, I had no idea how to lift
my family out of the distressing situation of financial hardship, especially when my father was struggling to repay
a medical loan. I wondered, Is there any way out of this nightmare?
The breakthrough came during my fifth-grade year in high school. I realized that education held the key to
changing our lives. Even though affording extra classes in math and science seemed like an unattainable luxury
when we struggled to put nutritious food on the table, I took charge of my education. I pushed myself to the limit
daily, completing my elementary school studies and ranking 10th in the sub-district in the scholarship examination.
It marked my first triumph, despite the odds stacked against me.

As a village boy, the idea of attending a city school was beyond our wildest dreams. Yet, with the encouragement
of my school teacher, I decided to try for the entrance exam. Out of over 30,000 candidates, I cracked the top 20
and earned a place at Rajshahi Collegiate School for the sixth grade. There, I became deeply involved,
participating regularly in science fairs hosted by various schools and research institutions, representing my school,
and nurturing a profound connection with electronics during this time.
When I grasped the concept of how a speaker works, I began to wonder if the process could be reversed. This led
me to explore how microphones convert sound into electrical energy, and I pondered the potential of using
sensitive microphones on a larger scale to convert sound into electricity.
I conducted an experiment where I connected a microphone to an electrical board and attached three LED bulbs.
Initially, the microphone didn't work due to a lack of power, so I connected a nine-volt battery. To my excitement, I
observed that the output voltage varied with the frequency of the sound in front of the microphone. This discovery
inspired me to present my project at a science fair organized by the Bangladesh Council of Scientific and Industrial
Research when I was in 9th grade. While this experience boosted my confidence and dreams, I later realized,
during a presentation to an electrical engineer, that my project had a small flaw – it relied on a battery to power the
LED bulbs. This revelation left me with questions; why the output voltage was high? Whether was it linked to
sound frequency? Is it possible to build it on a large scale which will continuously produce electricity?

Instead of confining my knowledge to textbooks, I set up a small workshop at home to work on science projects
that addressed practical issues. I created solutions such as an Ideal Sewerage System and Cleaning System for a
city, an Automatic Light Sensor Lamp for roads, and a Mini Projector for classrooms. I also experimented with
building High Power Lighting Systems using discarded mobile phone batteries, learning valuable lessons from
many failures along the way.
During this time, a series of accidents occurred on the railway due to the theft of railway sleepers in 2014. This
prompted me to think about a solution. I came up with the idea of creating a model railway with LED indicators to
monitor the railway sleepers' integrity. I connected the LEDs to an electric board, mimicking the layout of railway
sleepers using cork sheets. The challenge was determining the most cost-effective way to connect the LEDs to the
sleepers. I chose a series connection for cost efficiency. If a sleeper was stolen, an interruption in the monitoring
board would indicate the affected railway section. I presented this project at a Science fair in 2015 and won a prize
in a special category. These experiences have been instrumental in my life, motivating me to solve real-world
problems and make engineering more relevant to everyday life.
After completing high school, I took a significant step toward my engineering aspirations by enrolling in an
engineering program in my country. In my first year, I gained knowledge of Arduino and how to integrate various
sensors for engineering purposes. I also developed proficiency in programming languages like Python, basic
Matlab, and AutoCAD through university courses. While the global trend of incorporating artificial intelligence in
engineering and other sectors intrigued me, I was equally fascinated by the development of electronics and
semiconductor chips that provide the computational power necessary to achieve remarkable feats.
My choice to study Textile Engineering opened up intriguing possibilities in the field of electronics for wearables
and apparel. I've sought knowledge through online platforms, such as YouTube, and learned about research ethics
and methodology, including conducting literature reviews, identifying research gaps, and striving to generate
innovative, reproducible research. I've also recognized the importance of maintaining academic integrity and ethics
as a researcher.
However, life changes color with the curve of time, and we face situations that we may never imagine. During the
COVID-19 pandemic, my father lost his job, which was our family's sole source of income. The situation was a
bolt from the blue for us. In my second year of university, I had to put my studies on hold to support my family,
which was an incredibly difficult decision. To support my family, I was required to do anything and everything. As
a daily laborer, I queued in front of the road, waiting for someone who would give me work. Sometimes, I worked
as a cleaner and sometimes as a helper for another laborer. As an inexperienced laborer, I always got the lowest
wages.

Facing challenges with physical labor, I decided to utilize my knowledge up to the 12th grade. I began teaching
high school chemistry at a coaching center and later added math to my teaching repertoire. However, coaching
centers often demand hard work without proportional compensation. To increase my earnings, I started offering
private tutoring to students in their homes, primarily through a third-party service called Tuition Media. They took
a 50 percent commission from my earnings.
As I strived to demonstrate my dedication and responsibility as a teacher, I began receiving more tutoring
opportunities through Tuition Media. Eventually, I received a direct offer to work with Dhaka Tutors, an
organization that provides tutoring services. I took on a role as a moderator, continuing to support my family and
fund my younger brother's education to ensure he stays on the right path.
Despite numerous challenges, I never lost hope and looked for opportunities to make a positive impact. Working at
Dhaka Tutors in a position of responsibility allowed me to develop entrepreneurial, communication, and
organizational skills. In my role as a moderator, I designed a strategic plan for the platform's upcoming year, and I
successfully onboarded 10,000 new teachers to the platform—a significant achievement. I also organized subject-
specific training for teachers to enhance their teaching capabilities. To help students make informed choices, I
introduced subject-wise video tutorials showcasing teachers' skills, a unique feature on our platform. Currently,
Dhaka Tutors boasts more than 30,000 teachers who have taught over 150,000 students across Bangladesh,
including the capital, Dhaka. It has become the largest tutor-providing platform in the country.

I've been fortunate to work under the guidance of Dr. Mohammad Uddin Shiyak, an Assistant Professor in the
Department of Dyes and Chemicals Engineering. In this role, I had the opportunity to contribute to the 'Prototype
of C70 Carding Machine' project, which was generously funded with 300,000 BDT by the Vice-Chancellor of
Bangladesh University of Textiles. This experience provided me with valuable hands-on learning and a deeper
insight into technological advancements in the textile industry. I'm excited to continue my pursuit of knowledge
and innovation with a focus on advancing engineering and its practical applications.

As my situation improved, I recently had the chance to rejoin university for my second year. My primary life goal
is now to work on solving people's problems. I believe that by addressing challenges in people's lives, we can
enhance their quality of life and create a lasting impact. When I learned about the GKS program, I saw an
opportunity to turn this aspiration into reality. I'm drawn to the program because it offers a great chance, not only
for me but also for individuals facing financial difficulties. It promises exposure to diverse cultures, enriching my
personal growth, and expanding my global perspective through interactions with people from various countries.
I believe that each culture possesses unique knowledge, and by learning from different cultures and people, we can
merge this wisdom to create innovative solutions that enhance people's lives. My greatest aspiration is to make a
positive impact by solving problems and making life easier for others. Republic Of Korea is globally renowned for
its strong commitment to education, and it serves as a model for many third-world countries due to its resilience
and development following the Korean War of 1950. The country offers cutting-edge technology, top-tier facilities,
and experienced, friendly professors in the field of electronics engineering.

My life experiences have shaped me into a resilient individual with a never-give-up attitude, a strong desire for
learning, and a dedication to giving my best. I believe that I can adapt well to any challenges while studying in
Republic Of Korea, and I see GKS program as an opportunity to write the next chapter of my life—a story that
emphasizes perseverance and the potential for brighter days ahead.

2023-10-13 Ahtasum Nafis Date (yyyy-mm-dd)


Applicant’s Full Name Signature

FORM 3. STUDY PLAN


Language Study o Study plans to improve Korean/English language ability required for taking a degree
Plan course before and after you come to Korea.
Polishing up the Korean Language before arriving in Korea:
I'm initially focused on mastering everyday conversations needed for street directions and shopping, and the main
tools I'm using for learning are YouTube channels and websites. To get a solid grasp of the Korean language
alphabet, Hangul, I'm following resources like the Bangla YouTube channel Korea vs. Bangla TV, Masud's Korean
Language Class, and Billy Korean, who teaches in English.
Additionally, I'm making use of the Loecsen website for free classes, which has been a valuable source of learning.
Given that Korean is entirely new to me, I'm dedicating myself to repeated practice and revision to ensure I
understand and use the language effectively. Furthermore, I'm enrolling in a language center to gain comprehensive
proficiency in Korean. I've also found Korean dramas and short films to be highly beneficial in my language
learning journey.

Polishing up the English Language before arriving in Korea:


As I anticipate communicating and studying in English in South Korea, I'm confident that I won't encounter any
issues because I have been studying English for an extended period. However, I'm committed to further enhancing
my English skills and expanding my vocabulary. To achieve this, I regularly follow reputable English media sources
like CNN and BBC. Additionally, I find watching English documentaries to be an effective way to bolster my
proficiency in the language.

Polishing up the Korean Language after arriving in Korea:


Language learning goes beyond textbooks as each language has its unique dialect and pronunciation. To delve
deeper, I plan to immerse myself in the local culture by interacting with the people and experiencing their way of
life. My focus will be on engaging in cultural festivals and exploring historical and scenic locations. When attending
a Korean language school, I'll have the opportunity to delve into the culture, complete assignments and homework,
and engage in discussions with fellow students.
Mastering a language requires repeated practice and accurate application. To achieve proficiency in the Korean
language, I intend to implement specific strategies. One approach is to master a Bengali-Korean dictionary, which
will help me understand synonyms and antonyms for Bengali words, offering valuable insights into language
nuances. Another method I'm committed to is the use of sticky notes. I'll write Korean words on them and place
them around my study area and room to keep them in constant view, facilitating quicker language learning. My
primary goal for my first year of studying Korean in South Korea is to attain fluency, with an initial target of
reaching TOPIK level 4 within the first six months.

Polishing up the English Language AFTER arriving in Korea:


Upon my arrival in South Korea, I'll wholeheartedly focus on my departmental courses that are in English and work
diligently to complete them within the designated time frame.
Goal of study &
o Goal of study and detailed study plan
Study Plan
Selecting the right university is a daunting process. It's crucial to gather information about the university before
making a decision. Initially, I checked if my desired major was offered at the university. I also researched the
university's alumni, campus life, available clubs, research opportunities, and other relevant factors. In summary, I
firmly believe that Dong-A University is my ideal choice for higher education.

Why Electrical and Electronics Engineering?


Electrical engineering offers a wide range of applications that continue to expand over time. It presents unique
opportunities for skill development and aligns with my life's purpose. Nowadays, electrical engineering intersects
with various other fields, making a significant impact in areas like renewable energy, materials science, robotics,
mechanical engineering, aviation, and automotive industries. However, my greatest motivation lies in addressing
real-life challenges, enhancing people's quality of life, and contributing to problem-solving efforts. I envision
realizing my dreams at my desired university, honing my talents to their fullest potential. This way, I can make a
positive impact on my community and the world at large.

My Academic Goals
I'm not pursuing a degree for the sake of it; I'm determined to acquire practical skills. I've identified some intriguing
courses on the university website, including motion control, data analysis, electronic circuits, IoT, and sensors. My
approach is to set specific goals for excelling in these subjects and taking on active roles to achieve high grades. I'll
make a point to sit in the front rows of the class, collaborate closely with instructors, and consistently perform well
in class activities.
I also plan to engage in extracurricular activities, like club organizations and other groups, to enrich myself
personally and strike a balance between my academic and social life. A significant aspect of this will be taking on
leadership responsibilities. I intend to assume direct responsibility for group projects, class assignments, and event
organization.
Furthermore, I'm committed to maintaining my physical fitness. I'll do this by regularly using the university gym,
and I'll pay attention to my nutrition and ensure I get sufficient sleep. Given my strong interest in research since
childhood, I'll establish early contact with professors and aim to become part of their research labs, participating in
ongoing projects.

How To Achieve My Goals


I'm fully committed to achieving my goals and draw motivation from my challenging life experiences. The night
before each class, I'll prepare by studying in advance and noting down questions to ask the professor. I'll actively
assist my classmates with information, class notes, and establish a study group to enhance my communication skills
and social relationships.

Future Plan
o Future plan in Korea or another country after finishing GKS program
after Study
Upon completing my education, my goal is to return to my home country. I have ambitious plans to assemble a team
of young, visionary engineers who are dedicated to identifying and addressing real-life challenges. To effectively
tackle these issues, we'll bring together individuals with diverse engineering backgrounds. Our core team will also
establish smaller regional teams, each focused on addressing the unique problems within their respective areas.

Through our collective efforts, we aspire to drive substantial positive change throughout the country, ultimately
enhancing the quality of life for its people. I am committed to furthering my education to expand my knowledge and
skills in pursuit of these goals.

August, 2024
Preparing myself for
Undergraduate program

June-July, 2024
Started learning korean Language

Aprill- May, 2024


Adjust with new environments
August, 2024
Preparing myself for
Undergraduate program

June-July, 2024
Started learning korean Language

Aprill- May, 2024


Adjust with new environments

As I've mentioned before, my passion for teaching and the positive impact I've had on numerous students have
inspired me to establish an open school accessible to all. In this school, students will engage in discussions and
collaborate to develop solutions for real-world challenges with the guidance of experts.

Simultaneously, I aspire to play a role as a cultural liaison between Bangladesh and the Republic of Korea in the
years to come. My aim is to nurture strong, positive relationships between the people of these two nations.

February,
2025
March, 2027-
Accomplished March-Aprill, January, 2029
Korean 2025 May,2025- Persuing my 3rd February, 2029
Language February,2027
programm Adjusted with and 4rth year and Earned a
Studying my published a
with TOPIK new Environment engineering 1st and bachelor degree
and fully Research Paper
Level 4 2nd years and in Electrical
furnished with the participating in various
Engineering
extracurricular activities
personal
belongings

2023-10-13 Ahtasum Nafis Date (yyyy-mm-dd)


Applicant’s Full Name Signature

FORM 4. RECOMMENDATION LETTER


Instructions: Please fill in your name and other required information below and deliver (or email) this form to the person who will write the
recommendation letter. Request your referee to seal the letter of recommendation in an official envelope and sign across the back flap.
Recommendation letters that are not dated, signed, or sealed will not be accepted.

Name of Applicant: (Family Name) Ahtasum (Given Name) Nafis

Country of Citizenship: Bangladesh


Desired Degree Program: ✘ Bachelor’s Degree Associate Degree

Intended Major: Electronic Engineering

To be completed by the referee:

Your frank and candid evaluation of the applicant will be highly appreciated in the selection of Global Korea Scholarship
awardees and the admissions to a Korean university. We greatly appreciate your time and effort.

*You may use your own recommendation letter template and attach your letter to this form. We hope to glean the
following information of the applicant from your recommendation letter:

- How long have you known the applicant and in what relationship?
- What are applicant’s capabilities, strengths, and weaknesses? (in regards to academic achievement, passion and interest for intended
major, future academic potential, integrity, responsibility, independence, creativity, adaptability, communication skills, and others)
- Please comment on the applicant’s performance record, potential, or personal qualities which you believe would be helpful in
considering the applicant’s application for the proposed degree program.

Recommender’s Name Md. Mizanur Rahman

Recommender’s Signature Date 08/10/2023

Position or Title: Assistant Professor School (Institution): Rajshahi College, Rajshahi.

Address: Sagarpara, Ghoramara, Rajshahi

(zip-code: 6000 )

Email: [email protected] Tel: +8801779250253

! Instruction for the recommender: After completing the recommendation letter, please add date and your signature at the
bottom. Recommendation letters that are not signed and dated will not be considered valid. Please attach this form and your
recommendation letter sealed in an envelope (sign across the back flap) and deliver the sealed envelope to the applicant.

!! For the recommenders of Embassy Track Applicants: Please printout or make three additional photocopies of the letter you
wrote and sign all copies (1 original and 3 photocopied letters) respectively. Please enclose all 4 letters and this form altogether
min an official envelope and sign across the back flap.

FORM 5. GKS APPLICANT AGREEMENT

As an applicant for 2023 Global Korea Scholarship for Undergraduate degree program, I
agree to abide by the following;

(1) The information I have provided in this application forms are true and accurate and all
documents I submitted to the National Institute for International Education (hereafter NIIED)
are genuine. ✘
(2) I understand that all the documents submitted to NIIED for GKS will not be returned regardless
of the final outcome of the selection process. ✘
(3) I will abide by all the Korean laws and ordinances. ✘
(4) I will respect and uphold the values of the Korean culture and society. ✘
(5) I will fulfill my responsibilities as a GKS scholar to the best of my abilities. ✘
(6) I will not participate in any form of political activities (such as organizing or joining a political
party, attending political meetings, publishing articles and declarations, and organizing or
participating in political demonstrations). ✘
(7) I will maintain financial integrity at a personal level. ✘
(8) I accept NIIED’s decision concerning the degree program and the Korean language program.

(9) I understand that once I am selected as a GKS scholar. I am not permitted to change the
university, either for the Korean language program. ✘
(10) I will abide by the academic regulations and requirements of NIIED, Korean language
institution, and university. ✘
(11) I understand that if I have any dependents that will accompany me to Korea, I am responsible
for all matters concerning those dependents such as visa issuance and that NIIED will not
provide any extra expenses or support regarding my dependents. ✘
(12) I give permission to NIIED, the Ministry of Education of Korea, the Ministry of
Foreign Affairs of Korea, the Ministry of Justice of Korea, and affiliated institutions to use the
contact information provided in my application for the purpose of visa issuance,
communication, conducting surveys, and sharing information as needed. ✘
(13) I hereby authorize NIIED to verify the information disclosed in this application form
and the documents required by GKS as well as to collect any other information deemed
necessary by GKS to determine my suitability as an applicant from any institution, organization
or individual issuing said information and/or documentation. This includes but is not limited to
contacting recommenders or previous employers. ✘
(14) I hereby understand that all information provided to NIIED will be stored in secured
servers where access will be limited to GKS team and its affiliates. I understand that all
reasonable efforts will be made to protect confidential and sensitive information. By signing
below and submitting my application, I agree to these terms. ✘
(15) I understand that failure to uphold any of the above statements may be grounds for
termination of my scholarship offer. ✘

(continued in the next page)

「National Institute for International Education (NIIED)」 intents to collect and use your
personal information including disclosure to third parties for the GKS selection, based on the
「Personal Information Protection Act」 and its provisions. We will use the collected data only for
its intended purpose and inform the user for an agreement whenever the purpose of information
collection is changed. Please provide us whether you agree or not on the terms of personal data
collection and usage after referring to the information below.

Agreement on Collection and Use of Personal Data


NIIED collects and uses the applicants’ Personal Information; and is able to provide such information for a third party in
accordance with NIIED policy and regulations.
-
Personal Information Collected: name, date of birth, sex, nationality, contact information, TOPIK score,
career and educational record, university information applied, and language proficiency
- Purpose: Selecting GKS Scholar
- Retention Period: more than 5 years
① If you do not approve our collection and use of your personal information, you have the right to refuse to the use of
personal information mentioned above. However, due to your refusal, your application may be excluded in the selection
procedure.

✘ Agree Disagree
Agreement on Collection and Use of Sensitive Information
① NIIED collects and uses the participants’ Sensitive Information; and is able to provide such information for a third party
in accordance with NIIED’s policy and regulations.
- Sensitive Information Collected : Medical information
- Purpose: Selecting GKS Scholar
- Retention Period : At least 5 years for hard copy / 20 years for soft copy
② If you do not approve our collection and use of your personal information, you have the right to refuse to the use of
personal information mentioned above. However, due to your refusal, your application may be excluded in the selection
procedure.

✘ Agree Disagree

I confirm that I read all of the above conditions. I also understand that the violation of any one of
the above might result in warning or cancellation of the scholarship.

2023-10-13 Ahtasum Nafis

Date (yyyy-mm-dd) Applicant’s Full Name Signature


FORM 6. PERSONAL MEDICAL ASSESSMENT
Attention! This form is just a personal medical assessment and applicants do not need to get a comprehensive medical examination at this stage.
However, all applicants who pass the 2 nd round of selection must receive comprehensive medical checkup and submit an Official Medical
Examination issued by a medical doctor or a licensed hospital. (The Official Medical Examination form will be posted in the GKS Notice board
along with the announcement of successful candidates of 2 nd round of selection) After arriving in Korea, all GKS scholars will be subject to a
medical examination (including TBPE drug test) administered by NIIED in accordance with the requirements of the Korea Immigration Service.
If the results show that the applicant is unfit to study and live overseas, he or she may be disqualified from the scholarship.

Gender Male Female HEIGHT 168cm WEIGHT 83kg


QUESTION YES NO IF YES, PLEASE EXPLAIN
Have you ever had an infectious disease that posed a

risk to public health? (e.g. tuberculosis)
Do you have allergies? ✓
Do you have hyper tension? ✓
Do you have diabetes? ✓
Do you have any type of Hepatitis? ✓
Have you ever suffered from or been treated for
depression, anxiety, or any other mental or mood

disorder? (If you have received treatment, please
explain and attach an official medical report.)
Have you ever been addicted to alcohol? ✓
Have you ever abused any narcotic, stimulant,
hallucinogen or other substance, either legally or ✓
illegally?
Have you been hospitalized in the last two (2) years? ✓
Have you had any serious injury, ailment or sickness

in the last five (5) years?
Do you have any visual or hearing impairment? ✓
Do you have any physical disabilities? ✓
Do you have any cognitive/mental disabilities? ✓
Are you taking any prescribed medication? ✓
Are you on a special diet? ✓
Are you pregnant? ✓

2023-10-13 Ahtasum Nafis


Date (yyyy-mm-dd) Applicant’s Full Name
Signature

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