ICU Global IT Technology Program (ITTP) Application

I

Required Documents

0 Study Plan (See Attachment #1)

0 Personal data (Attachment #2)

0 Interested areas of study & Advisor (Attachment #3)

0 2 letters of recommendation - in English (Attachment #4)

* 1 additional letter of recommendation fiom the head of your organization/institution if you are applying for

special admission as a faculty member of foreign institution or an employee of foreign government.

0 Copies of diplomas fiom all previously attended college-level schools

0 Certified/ofEcial transcripts of all previously attended college-level schools

0 Certificate of TOEFL or IELTS score (original copy or directly sent fiom ETSOELTS)

(If not, other standards determined by ICU)

0 Copy of passp6rt

0 Proof of Immunization

0 Outline of master's thesis (for Ph. D. program applicants only)

0 Published papers, if available

0 Submitting Applications and Contact Information

Coordinator, Administration Office of ITTP

Information and Communications University (ICU)

1 19 Munji-ro, Yuseong-gu

.Daejeon, 305-732, Republic of Korea

Email: ittp@icu.ac.kr

Phone: +82 42 866 6845

Fax: +82 42 866 6858

Homepage: http://ittp.icu.ac.kr

Attachment # l

Study Plan

To be written by individual applicant

Photo (3 * 4)

(signature)

Full Name

Date of Birth

Nationality

Present Residence

'Ob Classification

Highest Degree Conferred or to Be

C o n f d

of Hi*cr Degree Pursuance in

Korea

Applying Degree Program In a Korean

University

La~guage Proficiency

Applicant's Name :

(Given name) (Family name)

OMale OFemale OSingle OMarried

6Y) (mm) (dd) (Age: 1

Address:

Tel.: (home) E-mail: (work) (mobile)

.-

0 Government officer 0 Professor in national univ.

~esearchcr in national institutions ,, Etc, Employees from .

Name of Univ.

Academic Degree

Title or Subject of Graduation Dissertation (Thesis) if Applicable

Duration of Study in Kana Estid

Univ' in

Academic Major

English Proficiency

(YY) (mm) (dd)

private institutions can't apply for ITTP.

Academic Major:

OMS OBS

Country/City

Grade Point AveragdGPA)

/ points (your score)/(perfect score)

(YY) (mm) - (YY) (mm) total period : (years) (months)

0 School of Engineering ICU(1nformation and communications ~niv . ) Department

Applying Degree Course OMS OPhD

OTOEFL points OIELTS ooints

0 Educated in English (Please submit a document of proof.) q Native Language

Attachment #2

Personal Data

1. Personal Background & Record

1) Academic Background

*) Write in chronological order including high school

**) Please choose the level of university you graduated among the followings;

1. Top 3 in the country 2. Top 10 in the country 3. Upper 20% 4. Upper 50% 5. Others

Period

m

m

LI

m

2) Academic Record

Academic Major Name of Univ.

.

*) Fill out both the records of BS & MS in the case of those who applying for a doctorate degree program

*) GPA(Grade Point Average) : your score I perfect score

*) Academic standing : your rank 1 total number of students in the class or major

Country Diploma or

D e p e

School

Year

Term

B.S

M.S

Academic

Adviser Level of Univ.**

Academic

Standing

I

I

1 * year 4"' GP A

I

I

1" 1'

Converted

Point

points

points

2"d year 3d year

2nd 2"d 3d l* I* 3d 3d 2"d 2d 3d

2. Study Background

Knowledge of

Major Field o your knowledge, education and work experience, etc in relation to major field

Reason for

Studying in Korea

.

Key Achievements o important books, thesis, report, patent, R&D achievement, prke-winning & scholarship

record, etc

3) Work & Research Experience

*) Write in chronological order

Period

- present

-

-.

4) Family Background

/

Institution or Company

(Name & Division)

Job DescriptionIDuty

(In detail)

r

Relationship Date of Birth. ; Name Occupation Residence/City

*

3. Study Plan

Goal of study &

Study Plan o goal of study, title or subject of the research and detailed study plan

Action Plan

after Study o Describe how to contribute to your country's IT industry afier completing the study

4. self Introduction

o Your course of life(growth process. home & social environment. etc), your view of Nfe, stu& background. your h o p

& wish, etc (within I page)

Attachment #3

Interested Areas of Study

* Number your preferred tracks of study up to 3. # 1 should indicate the area in which you are most interested.

School

School of

Engineering

.

Track

Ubiquitous Computing

Bioinformatics & Information Management

Software Engineering

Media and Interaction

Information Security

Internet

Optical Communication

Multimedia Communication & Processing

Wireless Communication

Radio and Bio Electronics

System on Chips

Technology Management

(Other-please specify)

Order of Preference*

Attachment #4

Letter of Recommendation

To the applicant: Please fill in your name and other information below. Deliver or mail this to the person who will

write this letter. Ask your recommender to seal this in an official envelope and sign across the back after it has been

written. Recommendation that are not sealed and signed will not be accepted.

Confidential

1. Name of Applicant: laiven name) (familv name)

fsienature) (date)

2. Nationality :

3. Desired Decree Proeram : n MS n P ~ D

To the recommender: The person named above has applied for 'ICU Global IT Technology Program(1TTP)'. We ask

your assistance, and would appreciate your frank and candid appraisal of the applicant.

1. How long have you known the applicant and in what relationship?

2. What do you consider to be the applicant's strengths?

3. What do you consider to be the applicant's weaknesses?

4. How well do you think the applicant has thought out plans for graduate study?

5. Do you know of any medical or emotional condition that might affect the applicant's performance at the

University? If so, please explain.

6. Please give us your appraisal of the applicant in terms of the qualities listed below. Rate the applicant in

comparison with others by marking on the table.

7. Please comment on the ratings that you have assigned in #6 and make any additional statement about the

applicant's record, potential, or personal qualities which you believe would be helpful in considering the

applicant's application for the proposed degree program.

Recommender's Signature

Recommender's Name Date

Position or Title:

School or Firm:

Address:

Academic

Achievements

Intellectual Skills

Research and

Creative Abilities

Interests and Motivations

Relevant Work Experience

Ability to Work with Others

Potential for Success

in Graduate School

(zip-code : Tel : Fax:

NIA Superior

(TOP 10%)

Average

(Middle nird)

Unusually

Outstanding

(Top 5%)

-

Please return this form sealed in an official envelope and signed across the back to the applicant. We greatly

appreciate your time on this letter for your recommender.

Poor

(Bottom Third)

h

Excellent

(TOP 15%)

Good

(Top

-- - -- - -

I Kelaya kan : Bidang & Instiiusi/Universiti KelaslCGPA Tahun (a) Sijil

(b) Diploma

(c) ljazah Pertama

I

(d) Ph.D/Sarjana/ Dip.Lepasan ljazah

Nama Kursus

Peringkat Kursus

, Nama lnstitusi

, TempatlNegara

, TarikhITempoh Kursus

, Penganjur

- 1 ( bulan)

Kursus yang pernah diikuti dalam tempoh 2 tahun yang lepas ( Sila buat lampiran jika mang tidak mencukupi)

Nama Kursus Anjuran Tempat TempohTTarikh

. Biasiswa yang pernah diterima : '

Penaja TarikhTTempoh Biasiswa Kursus Yang Diikuti Tempoh Kontrak

33. Nama Suami I lsteri : 34. Tarikh Lahir

35. Pekerjaan 1 Jawatan :

36. Alamat Tempat Bertugas :

Memohon Hadiah Latihan Persekutuan : Ya / Tidak Sesi :

139. Orang yang boleh dihubungi semasa kecemasan :

(a) Nama : (b) No. Telefon :

(c ) Alamat :

(a) Saya telah / belum mengisytiharkan harta.

(b) Saya pernah I tidak pernah memohon Hadiah Latihan Persekutuan :

Tarikh Permohonan :

(c ) Disertakan salinan dokumen-dokumen sokongan bertanda ( -1 ) yang telah diakui sah oleh pegawai kerajaan Kumpulan Pengurusan dan Profesional seperti di bawah :

(I) ljazah Pertama atau setaraf

(ii) Transkrip ljazah Pertama

(iii) ljazah Sarjana atau setaraf

(iv) Transkrip ljazah Sarjana

(v) Markah LNPT

(vi) Keputusan TOEFU IELTSI Bahasa lnggeris (SPM) (Permohonan ke luar negeri sahaja)

(vii) Sijil Perkahwinan (berkeluarga sahaja)

(viii) Sijil Kelahiran anak (berkeluarga sahaja)

(ix) Lain-lain dokumen sokongan

Sesi :

(d) Saya mengaku bahawa semua keterangan di atas adalah benar dan permohonan ini adalah lengkap. Sekiranya kenyataan yang diberikan tidak benar atau permohonan ini tidak lengkap, JPA berhak membatalkan permohonan atau Hadiah Latihan ini.

( Tandatangan Pemohon ) Tarikh:

H. . PWRAKUAN KETUA JABATAN (, Potong yang tidak benkaitan ) I

41. (a) SOKONGAN: Disokong I Tidak Disokong

(b) TINDAKAN TATATERTIB:

(c) Markah Laporan Nilaian Prestasi Tahunan

Ada 1 Tiada

(i) Tahun : (ii) Tahun : (lii) Tahun : (iv) Purata Markah :

Markah : Markah : Markah :

(d) Pegawai BOLEH 1 TlDAK BOLEH dilepaskan untuk menjalani pengajian pada sesi yang dipohon.

Saya mengesahkan bahawa semua kenyataan yang diberikan oleh adalah benar dan permohonan beliau

adalah lengkap.

Tarikh: ( I andatangan Ketua Jabatan)

Nama:

Jawatan:

Cop Rasmi Jabatan:

l ~ r n ~ r a m LDP -1 43. Tahun Penajaan =)I. Bil

Peringkat Pengajian En 46. Negara 1 T I Negara 2 -1 (jika ada )

Nama Kursus:

Bidang :

Instiiusi:

Tarikh Kursus

MULA T I T I 5 I . T e m o h I Hari 1 I Butan 1 I Tahun 1 dl

TAMAT T I T I ( Hari ) ( Bulan ) ( Tahun )

( Bulan ) m ( Hari )

Penganjur

llll Jenis Cuti Belajar I Hadiah Latihan ( dalam tahun )

Surat Kelulusan En

54. Tempoh Kontrak ( jika ada )

5. Negeri Lahir

Johor Keda h Kelantan Melaka Negeri Sembiian Pahang Perak Perlis Pulau Pinang Selangor Terenggan Wilayah Persekutuan Sabah Sarawak Lain-lain W.P. Labuan

Melayu Cina India Orang Asli Semenanjung Kadazan Kawekan/Dusun Murut Bajau, llanau Lain-lain Bumiputera Sabah Melanau l ban Bidayuh Lain-lain Bumlputera Sarawak Lain-lain

PANDUANKOD

10. 'Kecacatan

Buta Buta Warna Mendengar dengan alat bantuan Pekak BISU Gagap Cacat Ka ki Cacat Tangan Lumpuh Kecacatan Lain

B. BUTIR-RUTIR PERKHIRIMATAN SEKARANG

12. Klasifikasi Perkhidmatan

Pengangkutan Bakat dan Sen1 sains Pendidikan EkOnOmi Sistem Maklumat Pertanian Kejuruteraan Keselamatan dan Pertahanan Awam Perundangan Tadbir dan Diplomatik Pentadbiran dan Pembangunan Penyelidikan dan Pembangunan Mahir/Separuh Mahirnidak Mahir Sosial Perubatan dan Kesihatan Kewangan Polis Tentera

14. Gred Jawatan

Contoh: DSI =

I Perkhidmatan Awam Persekutuan 2 Perkhidmatan Awam Negeri 3 Badan Berkanun Persekutuan 4 Badan Berkanun Negeri 5 Penguasa Tempatan 6 Syarikat Kepentingan Kerajaan 7 Swasta

LAPORAN JAWATANKUASA LATIHAN KEMENTERIANIJABATAN UNTUK KURSUS DALAM PERKHIDMATAN

(Borang ini hendaklah DITAIP)

I 1. TAJUK KURSUS I . .

3. TEMPOH KURSUS 4. PENGANJUR

1 8. KEANGGOTAAN JAWATANKUASA LATIHAN I ASAS ASAS PERAKUAN

5. BIL. PERMOHONAN DlTERlMA 6. BIL. CALON YANG LAYAK 7. BUTIR-BUTIR CALON YANG DIPERAKUKAN (Sila buat lampiran jlka ruangan tklak mencukupi)

I 1. Nama : Jawatan:

Tarikh Lahir 1 Umur

Nama dan Jawatan Calon

Celon Te ta~

Calon S i m ~ a n a ~

.

2. Nama: Jawatan:

PENGERUSI:

Nama :

Jawatan:

AHLl : - t '

.................................................. b....\..............

(Tandatangan PengerusVSetiausaha)

Kelulusan I lnstitut I ' Tahun

Nama :

Jawatan:

Cop Rasmi Kerajaan:

............ ............................. Tarikh: :

PERAKUAN

Perkhidmatan Sekrnng

DENGAN PERAKUAN IN1 KETUA JABATANI KEMENTERIAN BERSETUJU MELULUSKAN PEGAWAl UNTUK BERKURSUS

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