BANG IL-YOUNG FELLOWSHIP

The Bang Il Young Foundation, 61, 1-ga, Taepyong-no, Chung-gu, Seoul, 100-756, Korea

Application Cover Sheet

■ The Completed application and all requested materials must be submitted

no later than November 15.

■ Information provided by the applicant will be used only in evaluating

the application and will be kept confidential.

■ Please type or print clearly.

_______   ________________________________________________________________________

Mr. / Ms.    Last (Family) Name                First Name                   Middle Name

Date of Birth  ______/______/______  Sex _________________________

(Month / Day / Year)                         (M/F)

(PHOTO)       Present Position   ______________________________________________

Business Address   _____________________________________________

Street Number                        City

________________________________________________________________

State/Province               Country                    Mail(Zip) code

Home Address      _____________________________________________

Street Number                       City

________________________________________________________________

State/Province              Country                    Mail(Zip) code

Phone No. (_______)_________________ / (______)__________________

Business                              Home

Fax No.    (_______)_________________ / (______)__________________

Business                             Home

E-mail       ____________________________________________________

Citizenship   ____________________________________________________

Previous Education ______________________________________________

College Name             Degree              Date received