GEO Graduate Scholarship Program of CUK
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  □ Master's Program   □ Doctoral Program  □ Integrated Masters-Doctoral Program   	
 Apply for Department / major  	 dep.________________ major___________________	
 For the Term beginning 	 □ Spring (March 1st)      □ Fall (September 1st) 	
 Personal Information 	
 Name(Family)            (First)                (middle)
 _____________________    ___________________   _________________	Sex	 □ male 
 □ female	
 Date of Birth ______________________________(mm/dd/yyyy)	Place of birth_____________________	
 Nationality __________________________	 First Language ___________________________	
 Passport Number ________________________	 E-mail Address __________________________  	
 Present Address ___________________________________________________________________________	
 Permanent Home Address _________________________________________________________________ 	
 Home Phone ________________________________ 	 Mobile Phone_______________________________  	
Indicated your knowledge of the language listed below.
   KOREAN                                       ENGLISH          
     □ fluently    □ fairly well   □ slightly         □ fluently   □ fairly well  □ slightly	
Language Proficiency Test Score	
□ TOEFL	□ TEPS	□ IELTS	
Score	Score	Score	
Registration#	Registration#	Registration#	
Date of Test(mm/dd/yyyy)	Date of Test(mm/dd/yyyy)	Date of Test(mm/dd/yyyy)	
 School Information(Graduate/Undergraduate/High school)	
Prior higher education 	Department 	Location
(city/state/country)	From	To	Date of Degree
(received or expected)	
Prior higher education 	Department 	Location
(city/state/country)	mo.	yr.	mo.	yr.	Date of Degree
(received or expected)	

								

 Financial Supporter   	
 Name _______________________________________	 Relation ____________________________________ 	
 Occupation _________________________________  	 Phone No. _________________________________	
 Address ___________________________________________________________________________________	
 Applicant's Signature / Certification of Accuracy
 (I certify that all information is factually true and honestly presented)   	
 Signature ____________________________________ 	 Date _______________________________________