(cutoff line) For the personal records of the test taker
Examination Number for the 2018 Overseas Special Proficiency Test of Korean History
Name Examination Number
Test Date September 8, 2018 (Sat) 1:30 pm-3:00 pm Examination Location
(Examination Hall) □ LA □ OC
✽Application Number :
The test taker should provide all the information requested in the above application form with the exception of the application number and the examination number
The test taker must bring the examination number and a valid photo ID on the day of test The test taker must arrive at the designated examination hall by 1:30 pm
The announcement of test results will be made on the websites of both the National Institute of Korean History (www.history.go.kr) and the Korean Education Center in LA (http://kecla.org)
For recordkeeping by relevant agency
Application Form for the 2018 Overseas Special Proficiency Test of Korean History
Name Date of Birth . .
Contact Information
Home Phone
Email @ Cell Phone
Nationality □ Korea □ USA □ Other ( ) Gender □ Male □ Female Occupation
Portrait Photo Attach Here
(3cm × 4cm) Examination Number
Examination Location
(Examination Hall) □ LA □ OC
✽Application Number :
<개인 정보 수집 관련 안내>
위의 개인정보(이름, 생년월일, 연락처 등)는 응시자의 본인 여부를 확인하고, 합격자 인증서 발급시 인적 사항 반영 및 한국역사문화탐방 초청 개별 연락을 위한 용도입니다. 수집된 개인 정보는 상기 목적 이외의 용도로 이용되거나 제3자에게 제공되지 않습니다. 개인정보 수집 목적에 동의하지 않을 경우 개인정보를 제공하지 않을 수 있으며, 그러할 경우 불이익(응시 불가 등)이 발생할 수 있음을 알려드립니다. 본인의 개인 정보 제공 동의 여부를 하단에 표시하여 주시기 바랍니다.
□ 동의합니다. □ 동의하지 않습니다. 이름: (서명)
<Regarding the collection of personal information>
The above personal information (name, date of birth, contact information) is to be used to confirm the identity of the test taker.
When the certification of passing is issued, test takers with high scores will be contacted individually based on the contact information to be invited to join thefield trip to learn about Korean history and culture. The collected personal information is not to be used for other purposes and will not be shared with a third party. Test takers who do not wish to share their personal information will not be forced to, but may be at a disadvantage (may not be allowed to apply for the test). Please check the following boxes to grant consent to provide personal information.
□ I grant consent. □ I do not grant consent. Name: (signature) Application Date 2018. . Applicant Name (Signature) Processed By Name (Seal)
