Ministry of Education Institute of APEC Collaborative Education

Government Complex-Sejong, 408 Galmea-ro, 63beong-gil 2, Busandaehak-ro, Geumjeong-gu,

Sejong, Republic of Korea (30119) Busan, Republic of Korea (46241)
www.moe.go.kr www.alcob.org / +82-704640-1210

[Appendix 3] Application Form: Students

Application Form for the 7th e-ICON World Contest

(For Students)

Name (First) Date of birth yy/mm/dd

(As shown in (Middle)
your passport) (Last) Gender □Male □Female Photo
Please upload your
□S □M □L profile picture.
Nationality (e.g., South Korea) T-Shirt size
□XL □XL
* Uploaded files must be in JPG
Passport No. format with an English filename
* Submit your copy of passport along with this application.
□ Standard (non-vegetarian) □ Vegetarian □ Halal food
Meal preference
□ Other (please provide details):

Medical □Healthy □allergies (details: ) □medication (details: )

Information □Previous illness (details: ) □Physical handicap (details: )
(Zip code: )
Address

Office +Country Code/Area Code/Number

Contact number e-mail
Mobile +Country Code/ Number

School School name / Grade

Classification English Other ( ) Certified language test score

Language
proficiency Writing English:
(Basic, Other ( ):
Intermediate, Listening
Only standardized international test scores are accepted,
Advanced) Reading e.g., TOEFL, TOEIC, and IELTS.

Date Details Reward Results

Experience of
participating in
ICT-related
contests

Date Details Country/region

Experience of
participating in
international
education
collaboration
activities
 SELF INTRODUCTION(Use additional spare if necessary)
Please explain specifically why you would like to participate in the e-ICON World Contest.

Please describe your individual unique merits, talents, and experiences that would help contribute to the activities
of the e-ICON World Contest.

Please describe your expectation for the 7th e-ICON World Contest and what this contest means to you.

Date: __/__/2017

(Applicant’s name and signature)

GUARDIAN’S CONSENT

Relationship to the applicant:

Name & signature:
Address:
Telephone:

I hereby give my consent for the above-named applicant to participate

in the 7th e-ICON World Contest.

※ In principle, ‘guardian’ refers to a parent. If the applicant’s parents are absent or deceased,
guardianship is limited to a member of the immediate family, a spouse, or a close blood relative.