🏛️ KING SEJONG LANGUAGE TRAINING CENTER

PROGRAM WITHDRAWAL APPLICATION FORM

CENTER INFORMATION

🏛️ SEJONG CENTER

📍 Location:

175 Sejong-daero (Sejongno) Jongno-gu, Seoul 110-821 KOREA

🏢 Business Registration: 101-82-06773세종문화회관

📧 Email: conntact@siteprofree.email

Application No: _____________ Date: ____________________

1. STUDENT INFORMATION

Full Name: ________________________________ _________________________________ (Family Name) (Given Name)

Student ID: _________________________ Enrollment Date: //____

Gender: □ Male □ Female Date of Birth: //______ (DD) (MM) (YYYY)

Nationality: _____________________________ Passport No: ____________________

Contact Information: Mobile Phone: ________________________ Email: _________________________ WhatsApp: ___________________________ KakaoTalk ID: __________________ Emergency Contact: ___________________ Relationship: __________________

Forwarding Address: ____________________________________________________ ____________________________________________________

2. CURRENT PROGRAM INFORMATION

Program Enrolled: □ General Korean Language Program □ Business Korean Program □ Academic Korean Program □ Cultural Integration Program □ Industry-Specific Training □ Other: ___________________________________________________________

Current Level: ____________________________________________________ Class/Section: ___________________________________________________ Instructor: _____________________________________________________

Program Start Date: //____ Last Date of Attendance: //____ Intended Withdrawal Date: //____

3. REASON FOR WITHDRAWAL

Primary Reason (Select one): □ Academic Difficulties □ Financial Reasons □ Health Issues □ Family Circumstances □ Relocation □ Visa Issues □ Personal Reasons □ Transfer to Another Institution □ Employment □ Other: ___________________________________________________________

Detailed Explanation:

Supporting Documentation Attached: □ Yes □ No

4. ACADEMIC STATUS

Current Attendance Rate: __________% Current Academic Standing: ___________ Completed Assessments: ____________________________________________ Outstanding Assignments: _________________________________________

5. FINANCIAL INFORMATION

Current Payment Status: □ Fully Paid □ Partially Paid □ Outstanding Balance: ________________

Refund Request: □ Yes □ No

If requesting refund: Account Holder Name: _____________________________________________ Bank Name: _____________________________________________________ Account Number: _________________________________________________ Swift Code (for international transfer): ___________________________

6. ACCOMMODATION STATUS

Current Accommodation: □ Dormitory □ Homestay □ Private □ None

Check-out Date (if applicable): //____ Key Return Date: //____

7. VISA STATUS

Current Visa Type: ________________________________________________ Visa Expiry Date: //____

Do you require documentation for visa cancellation? □ Yes □ No

8. STUDENT SERVICES

Please cancel/transfer the following services: □ Student ID Card □ Library Access □ Computer Lab Access □ Sports Facility Access □ Student Email Account □ Other: ___________________________________________________________

9. EXIT PROCEDURES CHECKLIST

Please complete the following before submission: □ Return all library books □ Clear any outstanding fees □ Return student ID card □ Return accommodation keys (if applicable) □ Complete exit interview □ Submit course feedback form □ Collect personal belongings □ Cancel/transfer membership services

10. FUTURE PLANS

After withdrawal: □ Return to home country □ Transfer to another institution □ Begin employment □ Other: ___________________________________________________________

Future Contact Permission: □ Yes, the center may contact me for alumni purposes □ No, please remove my contact information

11. DECLARATION

I, _______________________________, hereby:

Request to withdraw from the program as specified above
Understand this decision is final once processed
Accept the refund policy terms (if applicable)
Will complete all exit procedures
Will return all center property
Understand this may affect my visa status
Verify all information provided is accurate

Student Signature: ___________________ Date: //____

12. GUARDIAN CONSENT (If under 20 years)

Guardian Name: __________________________________________________ Relationship: __________________________________________________ Contact Number: ________________________________________________ Signature: ____________________________________________________ Date: //____

FOR OFFICE USE ONLY

Application Received by: ________________ Date: //____

Clearance Check: Academic Department: □ Cleared □ Pending Date: //____ Finance Department: □ Cleared □ Pending Date: //____ Library: □ Cleared □ Pending Date: //____ Accommodation: □ Cleared □ Pending Date: //____ Student Services: □ Cleared □ Pending Date: //____

Financial Settlement: Tuition Refund: □ Applicable □ Not Applicable Amount: ________________ Processed Date: //____ Deposit Refund: □ Applicable □ Not Applicable Amount: ________________ Processed Date: //____

Documentation: □ Withdrawal Letter Issued □ Attendance Record Provided □ Academic Transcript Issued □ Visa Cancellation Notice Issued (if applicable)

Final Status: □ Withdrawal Approved □ Withdrawal Pending □ Withdrawal Denied Effective Date: //____

Comments: _______________________________________________________ Processed by: __________________________________________________ Final Approval by: _____________________________________________

✨ Thank you for your time at King Sejong Language Training Center. We wish you success in your future endeavors! ✨