장학금신청서 (Scholarship Application)

광복회 워싱턴지회 “2025년 독립유공자 후손 장학사업”

Applicant’s Personal Information (신청자 인적 사항)

A. Name (Korean) *

B. Name (English) *

C. Gender *

M

F

D. Date of Birth (mm/dd/yyyy) *

E. Home Address *

F. E-mail Address *

G. Cell Phone

H. Home Phone

Confirmation of Descendants of Independence Activists (독립유공자 후손 확인)

I. Patriot’s Name (독립유공자 성명) *

J. MPVA Registration Number (보훈번호, 있을시 기재)

K. Relationship to the Applicant (자녀, 손자녀, 증손, 고손)

L. Independence Activity Category (운동 계열)

M. Applicant’s College Academic Records (신청자 학부 학적 사항)

N. Name of School

O. School Address

P. Name of Department

Q. Date of Admission

R. Expected Graduation Year

S. Major

T. Grade Point Average (GPA)

I agree to the collection and use of my personal information (name, date of birth, gender, contact information)
and academic background (school name, grade, department) as described above.

U. Agree / Disagree *

Agree

Disagree

I certify that all information provided in this application is true and correct.

V. Applicant’s name *

W. Signature *

X. Date *