Page 1 / 3

International Environmental Research Institute

International Internship Program

APPLICATION FORM
1. Personal Details
Applicant full name in English (as shown in your passport)
Surname/Family Name Given Name

Gender
Date of birth (yyyy/mm/dd)
M( ) F( )
Place of birth Nationality

Mailing address (permanent address)

Mailing address (current address)

Marital status (single / married / divorced / widowed) Email address

Contact no. (with country and area code) Fax no. (with country and area code)

2. Please list a name of the person to be notified, in case of emergency

Name

Mailing address

Contact no.

3. Knowledge of languages. Mother language: ______________________________

Read Write Speak
Other languages Not Not
Easily Easily Not easily Easily
easily easily
English

International Environmental Research Institute, Gwangju Institute of Science and Technology

Room no. 322, Environmental Samsung Building 123 Cheomdangwagi-ro (Oryong-dong) Buk-gu, 61005
Republic of Korea Tel (+8262) 715-3366 Email:ieri@gist.ac.kr Website: http://ieri.gist.ac.kr/eng/index.php
 Page 2 / 3

4. Higher education
Institution Attendance from / to
Degree Major subject of
(Name, place and
(Date awarded) From To study
country)

Current status (Bachelors students / MSc. Students / Ph.D. students / Post-doctoral)

Current affiliation

Academic advisor

5. Employment (Please provide your employment history, if any)

1.
2.
3.
6. Internship Experience in South Korea (Please provide the name of the
university / institute / company and the internship program participated, if any)
1.
2.
3.
7. Other Information
a) Scholarships

b) SCI Publications

c) Have you ever been convicted, fined or imprisoned for the violation of any law?
Yes ( ) No ( )
If yes, please give full details in an attached statement.

8. Please indicate your availability for the internship.

Spring: Early Feb - End of June 2020 / Fall: Early August - End of December 2020
Spring semester ( ) Fall semester ( )

9. Preferred Laboratory
International Environmental Research Institute, Gwangju Institute of Science and Technology
Room no. 322, Environmental Samsung Building 123 Cheomdangwagi-ro (Oryong-dong) Buk-gu, 61005
Republic of Korea Tel (+8262) 715-3366 Email:ieri@gist.ac.kr Website: http://ieri.gist.ac.kr/eng/index.php
 Page 3 / 3

Please suggest 3 professors in School of Earth Science and Environmental

Engineering that you wish to be assigned in the order of preference (1 top to 3 lowest)
A list of professors can be found here https://env1.gist.ac.kr/env1/  laboratories  click on
each laboratory website
a.

b.

c.
10. References / Academic advisor (Person who write your recommendation
letter)
Please write the detail information of the person who write your recommendation letter
(he /she must not related to you who are familiar with your academic qualifications and
character), and who have agreed to forward a letter of reference directly to IERI.
Title Full name

Email address Contact no. (with country and area code)

Profession

11. Agreement
I have read and fully understand the guidelines and conditions of the International
Environmental Research Institute International Internship Program, which include the
following:
(a) that I am responsible for obtaining necessary visas and required documents as
requested by IERI.
(b) that I shall fulfill the final report and presentation as requested by IERI by the end
of the internship program.

I CERTIFY that the foregoing statements and answers are true, complete and correct
to the best of my knowledge and belief.

Date :

Full name : Signature:

International Environmental Research Institute, Gwangju Institute of Science and Technology

Room no. 322, Environmental Samsung Building 123 Cheomdangwagi-ro (Oryong-dong) Buk-gu, 61005
Republic of Korea Tel (+8262) 715-3366 Email:ieri@gist.ac.kr Website: http://ieri.gist.ac.kr/eng/index.php