Application form (English)

※ Please fill out this form in Korean/English if possible!

Attach Name Anggun Citra Maqfira Height / Weight 153 cm/ 44 kg

Photo
Date of Birth (mm/dd/yyyy) ( 9 /1 / 1999 ) (20 )

Sex ☒ Male □ Female

(This program is only for female applicants, not male.)

Family Marriage ☒Married □Single

Address Komplek Damai Lestari Blok B No.11 Lamreung, Kec. Darul Imarah, Aceh
Besar, Aceh, Indonesia

Indonesian Country Indonesia

Nationality
of Residence

PASSPORT □ Yes ☒ No ( please let me know how long it will take to get it : days)
Possession

Occupation UIN Ar-Raniry Banda Aceh

(School/Company/
Organization)

E-mail Address Angguncitramaqfira1999@gmail.com

Phone Number +62-082366271420 Emergency Contact +62-081377001868

Information
(Parents, friends, etc.)

K-POP Related □ Vocal □ Dance □ Choreography □ Composition □ Rap

Talent(Multi-choice □ Play instruments( ) □ Others(I can understand korean )
Allowed)

Other Talent I know all about kpop Hobby Watch Korean drama

Social Media YouTube

Address
Instagram angguncitramaqfira

Facebook

Others
(Twitter, Weibo)
 Native Language indonesian

Korean Language □ O □ X

Communication Level (Intermediate)

Speaking/Listening (Intermediate)

Reading/Writing ( Low)

Other Languages Language (English ) Communication Level (Intermediate)

Language ( ) Communication Level ( Low/ Intermediate/ Advanced )

Language ( ) Communication Level ( Low/ Intermediate/ Advanced )

*Q&A

1. How did you get interested in K-POP? Because the members the boy group is
handsome

saya mulai bisa berbahasa korea dan mengetahui tentang

2. How did K-POP affect you?
semua yang berhubungan dengan korea

3. Who is your favorite K-POP star (whom you want to

Ikon
meet the most)?

4. What is your favorite K-POP song? Ikon- Long Time No see

5. Please write down all the K-POP stars or songs you can e.g.) Ikon – Love Scenario

cover. Lee Hi – Breathe

6. How long does it take you to cover a K-POP song? (how Dance : I can’t dancing

many times /how long) Song: 2 hours

7. Please fill out all the experience related to K-POP?

(including Broadcasting, Entertainment, Audition, Festival, I don’t have any experience

Awards)

8. What are your other talents rather than singing/ dancing? sports
9. Please fill out all the audition experience not related to

K-POP? (including Broadcasting Entertainment, Audition, I don’t have any experience, I just love K-POP

Festival, Awards)

I almost watched all Korean TV programs

10. Have you seen any Korean TV programs?
(Prodeuce 101/Goblin/ New Jorney to the west/ show me
(e.g. ‘Produce 101’/‘Goblin’/‘New Journey to the West’)
the money/ etc)

11. Have you been to Korea before?

No
(When/ Where / With whom/ Why/ How long)

12. If you've ever been to Korea, where have you been?

What was the most memorable/Impressive thing?

eat near
13. If you visit Korea what do you want to do the most? han river
because the atmosphere in the Han River is
very good
(Please write the reason)

I want to visit the 3 big agencies that

14. If you visit Korea where do you want to go the most? are JYP, YG and SM because there are many
famous artists
(Please write the reason)

Beef
15. If you visit Korea what do you want to eat the most?
because when I watch Korean drama there
are many scenes where they are eating beef
(Please write the reason) and it looks really good

16. Are you available to stay in Korea for around a

Not, because I am a college student
month(during March~April) (*If not, please write the reason.)

17. What do you think are the most attractive things

My personalities
about yourself?

18. When was the happiest moment in your life? When I know about K-POP

when I didn't pass in this program

19. When was the most difficult moment in your life?
 20. What is a final goal you want to achieve through K- I want to meet ikon at least once in a
lifetime
POP?

21. Any last comments or questions?

< A Guide for Additional Files >

① Application

② Attach Photos : A total of three photos

- From front / From Side / Full Length
(Photos from the front/side should be taken in a bust shot,

and full length should include full-length of your body from head to foot)
③ Attach Videos : A total of three videos
- Self-Introduction video/ K-POP cover dance video/ K-POP cover song(rap acceptable)

- Introduction (native language / Korean if possible) must be filmed in bust shot.

- Please tell us how much you love K-POP in your self-introduction video clip
(*Each video should not exceed more than 2 minutes)
※ Not with other members in your video. Please attach video of you alone.

- Please do not wear too much makeup.

- No Filter or Photoshop. No Camera App (e.g. SNOW, B612)

- Please attach photo/video in which your face is identifiable.

<Collection and use of personal information>

➀ Information to be collected: Photos, Occupation, Name, Sex, Social Media Address, Date of Birth, Family

Information, Marriage, Home Address, Phone Number, E-mail Address, School, Job, Videos You Submitted, Career.

➁ Collection and Use: Participation and acceptance of Mnet <유학소녀 : Ticket To K-POP> program.

➂ Limitation of using the information: personal information collected for Mnet <유학소녀 : Ticket To K-POP>

will be only limited to the end of the program and will maintain it from the day when you signed this consent to the day

when the purpose of collection, use and limitation of the information is served fully. Follow all CJ ENM laws about the

privacy.

➃ Disadvantage if one disagrees: If the person does not agree with the contents above, Mnet determines that she

does not intent to participate in the program. If she agrees, she must fully perform the task.

I give my consent to Mnet to collect and use my personal information

 for the work related to the program. □

NAME Anggun Citra Maqfira

( )