Application Form

Have you ever been to Korea before?

If yes, when and for what duration?

If any information is found to be false or misleading, selection may be canceled, airfare support may be revoked, and future participation may be restricted.

□Yes                     □No

(When, how many time and for what duration?)                      

(Purpose of the visit)                                

Name

*Name must match passport

(Full Name)

Last                    First                 Middle

                                                          (Korean Name), if applicable

Photo

Recent Color

Photo

(3x4cm)

Gender

□ Male         □ Female

Classification

□ Overseas Korean Adoptee

Date of Birth

yy/mm/dd

Place of Birth

(City/Town)

(Country)

Country of Residence

Nationality

Passport Info.

(Passport Number)

(Country of Issue)

(Date of Issue)

(Date of Expiry)

Contact Info.

(Home Phone No.)

(Cell Phone No.)

(E-mail Address)

(Current Mailing Address)

Emergency Contacts

1. Primary Contact

(Name)

(Relationship)

(Phone No.)

2. Secondary Contact

(Name)

(Relationship)

(Phone No.)

Language Proficiency

(Native Language)

□(High)    □(Medium)    □(Low)

(Korean Proficiency Level)

□(High)    □(Medium)    □(Low)

(English Proficiency Level)

□(High)         □(Medium)         □(Low)

Occupation

Name of Organization

(*If you have belonged to any groups for adoptees)

Careers, Expertise

Skills, etc

Write in detail for your careers,

expertise, skills

incl. engagement in Korean Adoptee Networks, if any.

Do you plan to stay in Korea before or after the program?

If yes, when and for how long?

□Yes                     □No

(When and how long?)                              

Dietary Requirements

Health Related Requirements

*Allergies or medical conditions

What motivated you

to apply to this

program and any expectations from the Gathering?

Introduce

yourself