Koica scholarship Program Master’s Degree Program in Policy Competency Based on ict convergence

Restriction on Food/Behavior/ Medication
Any restrictions on food, behavior, or medication due to health or religious reasons?
□ NO	□ YES >> □ No Beef □ No Pork □ No Fish □ Others( ) )

MEDICAL HISTORY QUESTIONAIRE (to be completed by the applicant)  
1. Present Status

1. 
   Do you currently use any drugs for the treatment of a medical condition? (give name & dosage)
   

   □ No	□ Yes >> Name of Medication ( ), Quantity ( )

2. 
   Are you pregnant? (female only)
   

   □ No	□ Yes >> ( months )

3. 
   Please indicate any needs arising from disabilities that may require additional support or facilities.
   

( ) Note: Disability does not lead to dismissal or exclusion from the Program. However, upon the situation, you may be directly inquired by the KOICA Program Manager for more detailed account of your condition.

2. Medical History

1. 
   Please fill in if there is any disease you currently have and had in the past.
   

(If hospitalized, give place & dates).

Past:__□_No__□_Yes_>>_Name_of_illness_(_),_Place__dates_(_)__Present'>Past:	□ No	□ Yes >> Name of illness ( ), Place & dates ( )
Present:	□ No	□ Yes >> Name of illness ( ), Present condition ( )

2. 
   Have you ever been a patient in a mental hospital or have been treated by a psychiatrist?
   

   Past:	□ No	□ Yes >> Name of illness ( ), Place & dates ( )
   Present:	□ No	□ Yes >> Present condition ( )

3. 
   High blood pressure
   

   Past:	□ No	□ Yes
   Present:	□ No	□ Yes >> • Present condition ( ) mm/Hg to ( ) mm/Hg • Are you taking any medicine? □ No □ Yes

4. 
   Diabetes (sugar in the urine)
   

   Past:	□ No	□ Yes
   Present:	□ No	□ Yes >> • Present condition ( ) • Are you taking any medicine or insulin? □ No □ Yes

5. 
   What illness(es) have you had previously?
   

   □ Thyroid Problem	□ Liver Disease	□ Heart Disease	□ Kidney Disease
   □ Tuberculosis	□ Asthma	□ Stomach and Intestinal Disorder
   □ Infectious Disease >> Specify the name of illness ( )
   □ Others >> Specify ( )

6. 
   Has the above illness(es) been cured?
   

□ Yes

□ No - Specify the name of illness ( ) - Present condition ( )

I hereby certify that the above information is true and correct.
, In addition, you agree that application acceptance and admission may be canceled
if there is any incorrect and untruth.


Date: Name : (Signature)
HANDONG GLOBAL UNIVERSITY
H ANDONG GLOBAL UNIVERSITY

Self-Introduction

About yourself; family background, academic achievements, extracurricular commitments and accomplishments, volunteer work, employment experience, and reasons for applying to HGU.

H ANDONG GLOBAL UNIVERSITY

Study & Research Plan

Please be aware, the study & research plan submitted with your application does not have to be the final research project: if you are made an Offer of Admission and complete registration at HGU, you will have the opportunity to refine your project through discussions with your supervisor. The main purpose of the proposal is to demonstrate that you have the necessary critical thinking skills, an understanding of the relevant research area and an appreciation of the demands of a research degree.


Master : Please describe within 1 ~2 pages.

classification	content
Research / topic area.
Please explain your study plan (Specific research question(s), Data collection methods and analysis Approximate research costs and planned funding source )
Other things

H ANDONG GLOBAL UNIVERSITY

Recommendation for University Admission

Name of applicant_____________________________________ Tel. No: ______________________

Applied course _______________________________________ E-mail: _______________________
Home Address _____________________________________________________________________

Type	Top 5%	Top 10%	Top 25%	Top 50%	Bottom 50%	Others
Level of Academic Knowledge
Sociability
Diligence
Independence
Creativity
Honesty
Faithfulness
Clarity of Linguistic (verbal) Expression
Responsibility

Describe the applicants’ strengths and weaknesses of scholastic ability in detail.
(Use more paper if needed)

I recommend this student because he/she is %of the class among the other students

Name of the recommender (signature) Date:
Relationship to the Applicant Status/Occupation Address
Tel. No: E-Mail: