차의과학대학교

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 【양식1】      2027학년도 재외국민               및 외국인 특별전형 학력조회 동의서

                                                    ▪Address  120, Haeryong-ro, Pocheon-si, Gyeonggi-do, Korea
                                                    ▪Phone   +82-31-850-9021~6,              9048, 9058~9
                                                    ▪E-mail    admissions@cha.ac.kr



                                               Request       for Attendance          Records      Verification

                                                                                                                                Date :  20   .    .    .

  To whom it may concern

     I am writing to       request     your   school's    assistance     with   our admission        process.
     Specifically,   we    need    you    to  validate    the   attendance       records    submitted       by   the   students     who    have    claimed
     to  previously     attend    your    school    and    are   applying     for  admission      to   CHA    University.     We    realize   that   it is  a
     cumbersome        task    and   one    you    are  not    obligated     to   carry   out,   but   it is  imperative      that   we   have    accurate
     academic      records    of   every    applicant     for  a  fair  evaluation      and   we    would     greatly    appreciate     your    help    with
     the matter. All      you    need    to  do is check       the  records of      the students       in the attached list, mark           the  enclosed
     sheet   with    appropriate      information,      and    email(admissions@cha.ac.kr)            the   completed       form    back    to   us.  Once
     again, thank      you for your assistance.
                                                Sincerely  yours,


                               Dean of Admissions           Office            ___________________________________
                                       CHA    University                                    (Signature)



                                                                  Letter    of Agreement

   To whom it may concern :

    I  attended     *                                               from  *                 to              *                           .
                                   (school name  )                                           (date )                    (date )

    I  hereby    acknowledge        that I have      applied to      CHA University        for admission       in the    2027 academic         year   and I
    give    my    full consent      so   that   CHA    University     can    request    my    attendance       records    from     the   schools    I  have
    previously     attended.
    In   this  regard,    I  would    like   to  request     you   to   provide     CHA    University     with   their   request     for  verification     of
    my    attendance records.

                                   Written by Applicant                                          Verified    by   Previously Attended School
       Date of Birth :       *                                                                 □ Correct                    □   Incorrect
                                                (Month)                 (Day)                  (Year)
       Date of Admission(transfer            from another school)           :
                         *                                                                     □ Correct                    □   Incorrect

                                                (Month)                 (Day)                 (Year)
       Date of Graduation(transfer to              another    school) :
                         *                                                                     □ Correct                    □   Incorrect

                                                (Month)                (Day)                (Year)
       *                                                                                       Additional     comments        :
                    Name                                      Signature
       Date  :     *                                                                           Signature
                                    (Month)                 (Day)                  (Year)
      ※ 지원자는        * 부분만 작성하십시오.
      ※ 본    양식을 재학한 국외 학교                수만큼 별도로         작성하여       제출하시기        바랍니다.