CHECK LIST OF DOCUMENTS

Application Number- To be filled in -

Applicant Name

Intended programInternational MS Program on Nuclear & Radiation

Safety Intended Department

Nuclear and Quantum

Engineering

Categories Check with R

Man

dato

ry d

ocum

ents

0. This CHECK LIST -

1. Admission Application Form

2. Statement of Purpose

3. Statement of Financial Resources

4. Two Letters of Recommendation from Teachers/Professors

5. A Letter of Recommendation from the Applicant’s Employer

6. Graduation, Degree/Diploma, Credentials Certificates

7. Transcripts of academic records

8. Certificate of Official English Proficiency Test

9. Curriculum Vitae

10. Copy of Passport

Optional

11. Awards, Honors, Prizes, Merits, Distinction, or Decoration

12. School Profile and Credit Rating System

13. ___________________________________

※ Shaded areas indicate mandatory fields that must be filled in. ※ Documents of No. 6, 7 & 8 must be submitted with official seals.

(Form 1: Front)(For the program of 2012)

KINS-KAIST International Master’s Degree Program on Nuclear and Radiation Safety

Attach a color-photograph taken within the past

2 months

Admission Application Form

Application Number

Full Name in English(Last/First/Middle)

<To be filled in> *English name should be identical with the names in passport.

Intended program

R M.S. M.S.+ Ph.D. Ph.D.

Passport Number

(If any)

Type ofScholarship

Self-supportParental/Individual sponsorApplying for KT&G-KAIST ScholarshipR Applying for Organization/Firm/Government Applying for KAIST Scholarship

Intended Major (Please, write the exact name of Department and/or Division at KAIST), and underline your intended major(nuclearor radiation).

Department :Nuclear and

Quantum Engineering

Division: International MS Program on Nuclear & Radiation Safety

Mailing Address (Notify us immediately in case of any change and put in correct information for mailing service )

StreetCity State ZIP code

Country (all correspondence shall be done via e-mail, thus, verify often your mailbox)

e-mail:

Mobile Phone

__________-_____________________(Country code) (Number)

Land Phone

_________-_________-_____________ (Country code) (Area Code) (Number)

FAX

Local telephone number in Korea, (if any) :

Place of Birth (city and country) Date of Birth (dd /mm/ yyyy)

Nationality Acquisition Date of Citizenship, if different from the original.

Marital Status : check with R Single Married

Gender : check with R Male Female

Academic Information

Classification

School Attended Grade Info

Name Department/Major Minor Dual

MajorDate of

Admission

Date of Graduation/

Expected Graduation

Your GPA(Earned/

Full Mark)Location Max.

PointMin. Point

BS

MS

Ph.D

(Form 1: Back)

Language Proficiency (Check with the mark, "")

Language Fluent Good Average Poor

Korean English

English ProficiencyTest Scores

PBT TOEFL

CBT TOEFL

IBTTOEFL TOEIC TEPS IELTS Other

Score Attestation/ExemptDate of Test

Publications (including graduation dissertation)

No Titles Name of Journal Date

1

2

3

4

5

Awards, Honors, Merits, Distinction, Decoration, Recognition Attach supporting materials with a list

No Title rank year Description

1

2

3

4

5

Work/Research Experience (Please begin with the latest one.)Period

(mm/yyyy)Name & location of workplace Position Type of work

fromto

 

   

   

   

I certify that all information given above is true and complete to the best of my knowledge. I understand that any omission or misrepresentation herein may result in cancellation of my admission to KINS-KAIST International Nuclear Safety Master’s Degree Program.

_______________________________ ____________________________ Applicant's Signature Date

(Form 2)(For the program of 2012)

KINS-KAIST International Master’s Degree Program on Nuclear and Radiation SafetyStatement of Purpose

Application Number Applicant’s Name

In the allotted space, write a detailed and accurate statement of your purpose and objective in pursuing your study at KAIST and KINS. Describe any work and/or academic experiences related to the program.

I certify that the above statements are true and correct. I understand that any misrepresentation herein may result in cancellation of my admission to KINS-KAIST International Nuclear Safety Master’s Degree Program.

_______________________________________________________ ______________________________________________

Applicant's Signature Date

(Form 3)(For the program of 2012)

KINS-KAIST International Master’s Degree Program on Nuclear and Radiation Safety

Statement of Financial Resources Section I : Personal and Family Information

Application Number Full Name (in English)(Last/First/Middle)

Intended ProgramInternational MS

Program on Nuclear & Radiation Safety

Passport Number

Applicant's Country of Citizenship:Spouse's Name (if married) : Spouse's Country of Citizenship :

Details of Dependents who will accompany you to KAIST including their age and relationship (Check with "" and describe) None

Dependents information

Name Age Relationship

Section II : Financial Assistance

Check () appropriate box(es) below that show sources of funding and provide the information requested.

Specify exact amounts in USDFirst Year (guaranteed) Ensuing Years (expected)

Sour

ce o

f Fun

ds

Self-Support : Amount you will pay for educational expenses at KAIST.

Total Total

※ Attach the bank statement indicating your capacity to pay/meet educational expenses at KAIST.

Parental and/or Individual Sponsor Total guaranteed support by individual sponsors.

Total Total

Sponsor’s Name Relationship※ For each sponsor, please, attach a notarized certificate or the file “Attestation of Financial Guarantee” after

downloading it and bank statement of the sponsor. R Sponsoring Organization, Firm, or Government Total guaranteed support by each sponsor.

Tuition & Fees: Tuition & Fees:As required by KAIST

Living expenses: Living expenses:As stated at the announcement

Sponsor’s Name Korea Institute of Nuclear Safety (KINS) Applying for KAIST Scholarship Tuition & Fees Living allowance

Both Applying for KT&G-KAIST Scholarship

Grand Total⊙Section III : Explanations and Comments Are you willing to study at KAIST with self-support? Yes Maybe No If not NO, please, explain how to finance your study and stay at KAIST :

I certify that all information given above is true and complete. I understand that any omission or misrepresentation herein may result in cancellation of my admission to KINS-KAIST International Nuclear Safety Master’s Degree Program.

__________________________________________ ______________________________________Applicant's Signature Date

Form 4-1:

For Fall Semester 2012 International Graduate Enrollment

LETTER OF RECOMMENDATION by Academic Professor

Please type or print neatly.

To be filled by the ApplicantName in English (last), (first) (middle)

Date of Birth Nationality

Intended Program International MS Program on Nuclear & Radiation Safety

Intended Department/Division Nuclear and Quantum Engineering

I hereby agree that this letter of recommendation remains strictly undisclosed, and will not request any reading or disclosure of information given in this letter.

_______________________________________ _______________________________________Applicant’s Signature Date (dd/mm/yyyy)

*English name should be identical with the names in passport.

Name in English (last), (first) (middle)

Position / Title

Affiliation

E-mail

Postal AddressZip code City Country

Telephone Fax

I hereby duly recommend the aforementioned applicant. I have carefully filled out this letter of recommendation by myself, and I am aware that my opinions provided herein may continue to serve as a reference in the subsequent admission process within KAIST.

_______________________________________ _______________________________________ Recommender’s Signature Date (dd/mm/yyyy)

To be filled by Recommender

APPLICATION NUMBER

To be filled out by KAIST

Please return this letter after sealing and signing across the back of the envelop by the deadline to:

KINS-KAIST Master’s Degree Program CoordinatorGlobal Human Resource Development DepartmentInternational Nuclear Safety SchoolKorea Institute of Nuclear Safety62 Gwahak-ro, Yuseong-guDaejeon 305-338, Republic of Korea

Contact Information: Phone: (+82-42) 868-0227, Fax: (+82-42) 861-4046 E-mail: k133knc@kins.re.kr Web: http:/ /inss .ki n s. re .kr

Background Information

Teaching Experience: ( ) years and ( ) months

How long have you known the applicant?: ( ) years and ( ) months

How well do you know the applicant?: very well well moderately do not know well

What are the three adjectives that come to your mind to describe the applicant? :

1) __________________, 2) __________________, 3) ____________________

Evaluation

1. Please give your opinion on the applicant’s qualifications and potential for academic and professional achievement in the field of the applicant’s application. (200 words or less)

2. Please rate the applicant in the table below, in comparison with all the students you have taught:

Exceptional Very Good

Above Average Average Below

AverageNo Basis

for Judgment

Remarks

Overall Academic Achievement

Academic PassionCreative Problem-solving AbilityResearch AptitudePromise as a professional

In the fieldInterpersonal Relationship

Leadership and Impact

Responsibility

IntegrityAbility to Cope with

HardshipsReading /Writing Ability in English

Listening/Speaking Ability in English

3. Please summarize your overall opinion on the applicant. (100 words or less)

Form 4-2:

For Fall Semester 2012 International Graduate Enrollment

LETTER OF RECOMMENDATIONby Academic Advisor

Please type or print neatly.

To be filled by the ApplicantName in English (last), (first) (middle)

Date of Birth Nationality

Intended Program International MS Program on Nuclear & Radiation Safety

Intended Department/Division Nuclear and Quantum Engineering

I hereby agree that this letter of recommendation remains strictly undisclosed, and will not request any reading or disclosure of information given in this letter.

_______________________________________ _______________________________________Applicant’s Signature Date (dd/mm/yyyy)

*English name should be identical with the names in passport.

Name in English (last), (first) (middle)

Position / Title

Affiliation

E-mail

Postal AddressZip code City Country

Telephone Fax

I hereby duly recommend the aforementioned applicant. I have carefully filled out this letter of recommendation by myself, and I am aware that my opinions provided herein may continue to serve as a reference in the subsequent admission process within KAIST.

_______________________________________ _______________________________________ Recommender’s Signature Date (dd/mm/yyyy)

To be filled by Recommender

APPLICATION NUMBER

To be filled out by KAIST

Please return this letter after sealing and signing across the back of the envelop by the deadline to:

KINS-KAIST Master’s Degree Program CoordinatorGlobal Human Resource Development DepartmentInternational Nuclear Safety SchoolKorea Institute of Nuclear Safety62 Gwahak-ro, Yuseong-guDaejeon 305-338, Republic of Korea

Contact Information: Phone: (+82-42) 868-0227, Fax: (+82-42) 861-4046 E-mail: k133knc@kins.re.kr Web: http:/ /inss .ki n s. re .kr

Background Information

Teaching Experience: ( ) years and ( ) months

How long have you known the applicant?: ( ) years and ( ) months

How well do you know the applicant?: very well well moderately do not know well

What are the three adjectives that come to your mind to describe the applicant? : 1) __________________, 2) __________________, 3) ____________________

Evaluation

1. Please give your opinion on the applicant’s qualifications and potential for academic and professional achievement in the field of the applicant’s application. (200 words or less)

2. Please rate the applicant in the table below, in comparison with all the students you have taught:

Exceptional Very Good

Above Average Average Below

AverageNo Basis

for Judgment

Remarks

Overall Academic Achievement

Academic PassionCreative Problem-solving AbilityResearch AptitudePromise as a professional

In the fieldInterpersonal Relationship

Leadership and Impact

Responsibility

IntegrityAbility to Cope with

HardshipsReading /Writing Ability in English

Listening/Speaking Ability in English

3. Please summarize your overall opinion on the applicant. (100 words or less)

Form 5:

For Fall Semester 2012 International Graduate Enrollment

LETTER OF RECOMMENDATIONby Current Employer

Please type or print neatly.

To be filled by the ApplicantName in English (last), (first) (middle)

Date of Birth Nationality

Intended Program International MS Program on Nuclear & Radiation Safety

Intended Department/Division Nuclear and Quantum Engineering

I hereby agree that this letter of recommendation remains strictly undisclosed, and will not request any reading or disclosure of information given in this letter.

_______________________________________ _______________________________________Applicant’s Signature Date (dd/mm/yyyy)

*English name should be identical with the names in passport.

Name in English (last), (first) (middle)

Position / Title

Affiliation

E-mail

Postal AddressZip code City Country

Telephone Fax

I hereby duly recommend the aforementioned applicant. I have carefully filled out this letter of recommendation by myself, and I am aware that my opinions provided herein may continue to serve as a reference in the subsequent admission process within KAIST.

_______________________________________ _______________________________________ Recommender’s Signature Date (dd/mm/yyyy)

To be filled by Recommender

APPLICATION NUMBER

To be filled out by KAIST

Background Information

Teaching Experience: ( ) years and ( ) months

How long have you known the applicant?: ( ) years and ( ) months

How well do you know the applicant?: very well well moderately do not know well

What are the three adjectives that come to your mind to describe the applicant? :

1) __________________, 2) __________________, 3) ____________________

Evaluation

1. Please give your opinion on the applicant’s qualifications and potential for academic and professional achievement in the field of the applicant’s application. (200 words or less)

Please return this letter after sealing and signing across the back of the envelop by the deadline to:

KINS-KAIST Master’s Degree Program CoordinatorGlobal Human Resource Development DepartmentInternational Nuclear Safety SchoolKorea Institute of Nuclear Safety62 Gwahak-ro, Yuseong-guDaejeon 305-338, Republic of Korea

Contact Information: Phone: (+82-42) 868-0227, Fax: (+82-42) 861-4046 E-mail: k133knc@kins.re.kr Web: http:/ /inss .ki n s. re .kr

2. Please rate the applicant in the table below, in comparison with all the students you have taught:

Exceptional Very Good

Above Average Average Below

AverageNo Basis

for Judgment

Remarks

Overall Academic Achievement

Academic PassionCreative Problem-solving AbilityResearch AptitudePromise as a professional

In the fieldInterpersonal Relationship

Leadership and Impact

Responsibility

IntegrityAbility to Cope with

HardshipsReading /Writing Ability in English

Listening/Speaking Ability in English

3. Please summarize your overall opinion on the applicant. (100 words or less)