This certificate will be highly appreciated in the process of selection of Korean Government Scholarship recipients and the admissions to a Korean university. Please attach evidential documents which prove that the result of the following examinations is true and correct; otherwise, it is not valid.
① When and for what reason did you last consult a physician? (Please explain)
③ Have you had any serious ailment, injuries or diseases (high blood pressure, diabetes, tuberculosis, any type of Hepatitis, HIV, etc) in the last five years? (If yes, please explain)
④ Have you been hospitalized in the last two years?
(If yes, please explain)
⑤ Have you ever been treated by a doctor for any mental, emotional, or anxiety disorder?
(If yes, please explain and attach a report from your doctor)
⑥ Have you ever been addicted to any substance?
(If yes, please explain)
⑦ Do you have any allergies? (If yes, please list them)
⑧ Do you have any visual or hearing impairment?
⑨ Do you have any physical disabilities?
⑩ Do you have any cognitive/mental disabilities?
⑪ Are you taking any prescribed medication?
(If yes, please explain)
⑫ Are you on a special diet?
(If yes, please explain in detail)
⑬ Have you ever suffered from depression?
(If yes, please explain)
THE ANSWERS I HAVE GIVEN ABOVE ARE TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE. IF MY ANSWERS CONTAIN ANY KIND OF FALSEHOOD, I WILL TAKE ANY LEGAL RESPONSIBILITY.