For CNU office USE only # Chungnam National University

College of Pharmacy

International Student Application

To the applicant: If you wish to apply for an exchange program at Chungnam National University, you must be officially nominated by your home university. Complete application packages for respective programs must be sent using e-mail to the exchange coordinator (Prof. Hwi-yeol Yun: hyyun@cnu.ac.kr) and supervisor at Chungnam National University. Ensure that this application must be signed by the exchange liaison officer of the students' home university. Please complete the typable fields of this application. After printing, sign and date at the end of this form.

Application Deadline:

Proposed Program: Pharmacy practice course

Application Check List:

A complete International Student Application

A copy of passport (Identification page only)

Choose program(s) to take part in:

4-week (hospital & community pharmacy)

10-week (4-week program + research at institute and/or university)

6-month (4-week program + research at institute and/or university)

Suggest your available time period:

Personal Data

Last(Family) Name

First Name

Middle Name

Date of Birth

Country of Citizenship

Male Female

Single Married

Photo

Address (Street#. Apt #)

City or Town

Country

Province or State

Zip Code

Home Phone Number (Include Country Code

Cell/Business Phone Number

E-Mail Address

Emergency Contact Information

Name

Relation

Address (Street#. Apt #)

City or Town

Country

Province or State

Zip Code

Home Phone Number (Include Country Code

Cell/Business Phone Number

E-Mail Address

Immigration Status in Korea

I already have a Student Visa.	Date of Visa Obtained Valid

Until I have applied or will be applying for a Student Visa.

I do not require a visa for a short visit.

Academics

List all post-secondary and secondary you attended or attending. (Begin with the most recent since high school)

Institution1 (Full Name)

Department

Location (City, State, Country)

Major Degree granted/expected

Date Attended:	From To

Institution 2 (Full Name)

Department

Location (City, State, Country)

Major Degree granted/expected

Date Attended:	From To

Institution 3 (Full Name)

Department

Location (City, State, Country)

Major Degree granted/expected

Date Attended:	From To

Language Proficiency

Korean

English

Others

Housing Preference

[Choose one below]

On campus housing (Dormitory)

Double occupancy room Quad (4) occupancy room	Family room

Off campus housing

Studio type

* For off campus housing option, you are responsible for security deposit, monthly rent and other related fees.

Extracurricular and Professional Experience

Please list all relevant experience in a chronological order

[Experience 1]

Name of Organization

Period	From	To

Location (City, State, Country)

Position Type of work

[Experience 2]

Name of Organization

Period	From	To

Location (City, State, Country)

Position Type of work

Home University Officer Approval

I hereby certify that this student has been officially nominated by our university to participate in the respective program at Chungnam National University.

Name Position

Signature Date

Address (Street No. Apt No. Box No)

City or Town Province or State

Country Zip code

Required Signature by the Applicant I certify that all information submitted in the admission process including all supporting materials is my own work, factually true, and honestly presented. I understand that inaccurate, misrepresentation and falsification of documents may affect admission status, including admission revocation and expulsion. I agree, if admitted to College of Pharmacy, Chungnam National University, to comply with the university regulations stated in the University provisions. Name Signature Date

(This page should be written in handwriting. Please scan and attach this page when you submit the application.)