<사회통합프로그램 이민자 멘토와의 대화> 신청서(Application for <KIIP Immigrant Mentoring Program>)-잠시딘(KHODJIMUKHAMEDOV JAMSHIDIN)

법무부 대구출입국외국인사무소 주최 / 영남대학교 국어문화연구소 주관 /  10.5.(토) 15:00~17:00 영남대학교 국제교류센터 301호/잠시딘(우즈베키스탄) / ※ 신청기한: 10.3.(목) 16:00 (조기 마감 가능) ※ 본 프로그램은 한국어로 진행됩니다. (Hosted by the Ministry of Justice, Organized by Yeungnam University Institute of Korean Language & Culture, Khodjimukhamedov Jamshidin from Uzbekistan, 15:00~17:00, Saturday, October 5, Room 301 of International Center of Yeungnam University,  ※ Deadline for application: 16:00, Thursday, October 3, 2019, Please note that the application period may end earlier. ※ This program is delivered in Korean.)
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1. 이름(Name) *
※ 외국인은 외국인등록증 상 영문명 기재(If you are a foreigner, please fill in your name in the blank as it appears on the alien registration card.)
2. 성별(Sex) *
3. 생년월일(Date of Birth) *
※ 주민(외국인)등록번호 앞 6자리(Please write down the first six digits (YYMMDD) of the resident/alien registration card.)
4. 연락처(Contact) *
※ 숫자만 기재(Please type in numbers only.)
5. 내외국인 여부(Nationality) *
※  '외국인' 응답자 6~9번 문항 응답 필수(If you are a foreigner, please answer from Q6 to Q9.)
6. 국적(Where are you from?) *
※ 귀화자는 귀화하기 전 국적을 기재(If you are a naturalized Korean, please write the former nationality.)
7. 체류유형(Status of Stay) *
※ 4번 문항 '외국인' 응답자 필수 / 내국인 및 미해당자는 '해당 없음' 체크(Those who chose "Foreigner" in Q4 are required to answer this question. If you are a Korean or this question does not apply to you, please choose the option "N/A".)
8. 사회통합프로그램 수강 여부(Are you taking the KIIP currently?) *
※ 4번 문항 '외국인' 응답자 필수 / 내국인 및 미해당자는 '해당 없음' 체크(Those who chose "Foreigner" in Q4 are required to answer this question. If you are a Korean or this question does not apply to you, please choose the option "N/A".)
9. 현재 사회통합프로그램 교육단계(What level in the KIIP are you taking currently?) *
※ 멘토 교육 당시 참여하고 있는 단계 기재 / 7번 문항 '있음' 응답자 필수 / 내국인 및 미해당자는 '해당 없음' 체크(Please choose the level you are currently in as of the date you are joining the mentoring program. Those who chose "Yes, I am." in Q7 are required to answer this question. If you are a Korean or this question does not apply to you, please choose the option "N/A".)
10. 사회통합프로그램 운영기관(In which institution are you taking the KIIP?) *
※ 정확한 기관명 기재 요망(이수 시간 입력 시 필요) / 7번 문항 '있음' 응답자 필수 / 내국인 및 미해당자는 '해당 없음' 입력(Please write down the exact name of the institution (for calculating the total hours). Those who chose "Yes, I am." in Q7 are required to answer this question. If you are a Korean or this question does not apply to you, please write down "N/A".)
11. 참석 희망 교육(Which program would you like to join?) *
※ 타 멘토 과정을 중복 수강하여도 사회통합프로그램 출석시간은 2시간만 인정됨. (Even if you participate in more than one  mentoring programs, only two hours are counted as attended hours of the KIIP. )
12. 멘토에게 하고 싶은 질문(Questions for the mentor)
※ 한국어로 작성 요망 (Please write in Korean.)
13. 개인 정보 제공 동의 여부(Do you agree to provide your personal information?) *
본인은 <사회통합프로그램 이민자 멘토 교육> 신청 및 운영을 위한 인적사항 등 개인정보 이용에 동의합니다. 1) 이용 및 보유 기간: 제공일로부터 1년(보유기간 경과 시 즉시 폐기, 개인정보보호법 제15조 및 제 24조 의거) 2) 거부 시 불이익 조치: 개인정보 이용 부동의 시 본 교육 신청 불가(I agree to provide my personal information for application for and operation of <KIIP Immigrant Mentoring Program>. 1) The personal information is used and retained for one year from the date of its provision. (It will be disposed of as soon as the period of retention ends under Article 15 and Article 24 of the Personal Information Protection Act. 2) Those who deny consent will not be able to apply for the mentoring program.)
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