Only for officials

/ / . No.

Pukyong National University

Korean Language Program
Application Form

Application Information
(please read the PKNU Admission guidebook before filling out)

Type of application  Type A □ Type B □ Type C

Starting semester Year ( 2024 ) □ Spring □ Summer □ Fall  Winter

Enrollment period □ 1 semester  2 semesters

Dormitory  Yes □ No Pick-up service □ Yes  No

* Dormitory rooms are available for applicants one month after the opening day of the summer &
winter semesters.

* Pick-up location: Busan(Gimhae) International Airport, Busan Station.

Personal Information

Name (same as passport) GRISELDA GABRIELLA ODETTE

Gender □ Male  Female Nationality Indonesian

Date of Birth(YYYY/MM/DD) (2006/07/02) Passport no. E2631353

Alien card no. (holders Current visa
only) type
103-804, 17, Dusan-ro 9-gil, Geumcheon-gu, Seoul, Republic of Korea
Mailing address 08525

Address in home country Perum Jati Residence 1 Kav.14, Br. Bedha, Bongan, Tabanan, Bali 82112

E-mail [email protected] Kakao Talk ID

Phone no. National code +( 62 ) - phone no. ( 812-4288-3359 )

Academic Background

Name of final graduated school SMA Negeri 2 Tabanan (Public High School)
(photo) Degree title Senior High School

Date of graduation(YYYY/MM) (2024/05)

 School location (city, country) (Tabanan, Indonesia)

Korean Language Proficiency

Have you studied the Korean language

 Yes (please fill out information below) □ No experience
before?
TOPIK certificate
□ Level 1 □ Level 2 □ Level 3 □ Level 4 □ Level 5 □ Level 6
(holders only)
1~200 hours 201~400 hours 401~600 hours 601~ hours
Total hours of study


Placement test  Yes, I would like to take it □ No, I don’t want to take it
* If you choose ‘No experience’, you will be automatically placed into Level 1 without a placement test.

* The school will provide information about the placement test to applicants before the course starts.

Sponsorship & Emergency Contact

Sponsorship
Self-funded
□ Yes  No (please fill out information below)
applicant
Name of sponsor Kim Young Uk

Relationship Brother-in-Law

Phone no. 010-5255-0377

Emergency Contact
Name Febe Terepina Cornelia
In your home
country
Relationship Mother
(family)
Phone no. +62 813-5562-6069

Name Kim Young Uk

In Korea (if you
Relationship Brother-in-law
have)
Phone no. 010-5255-0377

Study Plan & Additional Information

 (Please select one or more)
 To apply for an academic degree ( Undergraduate □ Graduate)
What is your purpose to
 To enhance Korean proficiency
learn Korean?
 To experience Korea
□ Other:

Name of agency

Agency information Person in charge

(if applicant used an
agency) Agency phone

Agency e-mail

Self-introduction
(Please write a brief introduction about yourself, the reason why you chose PKNU and about your future
plans)

My name is Gabriella Odette Griselda, I’m thrilled at the prospect of embarking on a new journey
abroad, I’m eager to learn new things and to convince everyone that I can do it. When I was in junior
high school, I dreamed of studying abroad. I imagined learning a foreign culture, using a new language,
and making international friends. But as time went by, I felt all my enthusiasm and hope die out due to
some circumstances and limitations that wouldn’t allow me to pursue my dream . In the midst of
disappointments, my brother in law and sister offered me to study in Korea. I gladly accepted this great
opportunity that would not come a second time.

I chose Pukyong National University because of its welcoming environment for international students,
it also offers a major that stands out to me which is Global and Interdisciplinary Studies. I was
interested in the department because of its unique curriculum and the opportunity it offers to delve into
various fields of study. As I approached my high school graduation, I was still uncertain about my major
but Pukyong National University’s program aligns perfectly with my desire to better understand myself
and explore new areas of interest. Studying at Pukyong National University will not only allow me to
gain valuable knowledge but also enable me to connect with students from different backgrounds,
engage in cultural exchanges and participate in activities that will enhance my skills.

After graduation from the university, I would like to continue broaden my horizon by working abroad
in a field related to my major. In addition to it, when the time is right, I hope to pursue further studies in
another country to deepen my understanding and build upon the foundation laid at Pukyong National
University.
 Provision and Use of Personal Information Consent Form

 For admission into the Korean Language Program

 For the creation of student records and for student management,
Purpose of collecting and
etc.
using personal information
 Support for international students, such as immigration, registering
for insurance, etc.

 Personal data (name, birthdate, ID card number, email, cellphone

number, etc.)
Types of personal
 Verification information at the time of admission, such as academic
information to be collected
and financial background
 Emergency contact information (cell phone, address, etc.)

Period of retention and use  Until the end of the admissions screening process
of personal information (During the enrollment period for successful applicants)

We inform all applicants that they have the right to refuse to submit the provision and use of
personal information consent form, however if the consent form is not submitted, the applicant
cannot apply for the Pukyong National University Korean Language Program.

○ I understand that Pukyong National University may need to use my personal information,
etc. during the Korean Language Program admission screening, and for this purpose I agree to
the collection, use, and provision of personal information in accordance with the 「Personal
Information Protection Act」 and other relevant laws as well.

○ I certify that all information submitted in the application process is complete, accurate,
and honestly presented, and I understand that any inaccurate information may affect my
admission including cancellation of admission after enrollment.

I choose to apply for the Pukyong National University Korean Language Program after
checking all the above conditions.
Date(YYYY/MM/DD) : 2024/08/30 ( Signature )