PROGRAM APPLICATION FORM

1. PROGRAM APPLICATION FORM Attach Your Scanned Photo Seoul Human Resource Development Center Metropolis International Institute Headquarter Nambusunhwan-ro 340-gil 58, Seocho-gu, Seoul, 137-071, Korea Phone: 82 2 3488 2059 Fax: 82 2 3488 2346 Web : www.seoulmiti.org or www.metropolis.org/MITI E-mail: shrdcinfo@gmail.com Note: Please type in the form in English alphabets or tick(√ ), do not in hand-write for legibility “N/A” should be used where applicable. Do not leave any space blank. Ⅰ. PROGRAM TITLE : (Given/First) (Surname/Last Name) Ⅱ. PERSONAL DATA : Emergency Contact Name : (Relationship: ) Emergency Contact Number : (country code) (city code) (number) Dietary Request: ※ VISA: I need an invitation letter to apply for entry visa issuance. Yes ( ) / No ( ) Ⅲ. ORGANIZATION INFORMATION & TRAINING EXPERIENCE Present Job Title: Department / Division: Name of City / Organization: Address: Type of Organization: - City/Local Government ( ) - Autonomous Institution of City/Local Government ( ) - Other ( please specify : ) Term of Employment: from ( ) to present

2. Ⅲ. ORGANIZATION INFORMATION & TRAINING EXPERIENCE (Continued) Description of Duties / Responsibilities: Training experiences in Korea during last 5 years Yes ( ) No ( ) If “Yes” Please Specify Name and Period of Program : Organized by : Ⅳ. ENGLISH PROFICIENCY *Please tick(√) the box. Native Language: Other Language(s): V. STATEMENT OF MOTIVATION AND WHAT YOU WANT TO LEARN 1. Knowledge/Technology Level In your opinion, on a scale from 0 to 10, what is the knowledge/technology level of your city and Seoul in regards to the training subject *Please tick(√) the box. ( For example, in e-Government field, internet penetration ratio can be used as benchmark) Your city Seoul 1 (low) 5 10(high) 1 (low) 5 10(high)

3. 2. Please state your training goals. How will your participation benefit your career and/ or your city/ organization? 3. Please specify what would you like to learn from the training? (The training curriculum is not finalized and subject to change. You also can state particular themes of lecture or site visits that you would like to propose for the curriculum) 4. What is the major policy and pending issue of your city in regards to the training subject? 5. If there are pending issues, what are the obstacles in resolving them? (The reason why it is difficult to solve)

4. If accepted as a participant, I agree: • To follow the training program to the best of my ability and abide by the rules of the SHRDC during the training program; • To refrain from engaging in political activities, or any form of employment for profit or gain; • To return to my home country upon completion of my training program and to resume work in my country; • To accept that the SHRDC is not liable for any damage or loss of personal property; and • To acknowledge that the SHRDC will not assume any responsibility for illness, injury, or death arising from extracurricular activities, willful misconduct, or undisclosed pre-existing medical conditions. Date (dd/mm/yyyy) : Name of Applicant : Signature :

5. Dear President of SHRDC: Upon understanding goals and objectives of your international training program and with the hope of promoting our knowledge and experience exchanges, I hereby recommend the following person as our city’s representative in your program. I guarantee that our applicant will abide by all laws and rules of your city during the program period and will resume his/her job upon completing the course. Applicant’s Profile • Name of Training Program : • Applicant’s Name : • Present Job Title : • Department / Division : • Name of City / Organization : Recommender’s Profile • Recommender’s Name : • Present Job Title : • Department / Division : • Name of City / Organization : • Contact Information - Tel - E-mail (We may contact you during applicants’ selection process) Date(dd/mm/yyyy): Signature: