붙임 1		2025년 다문화가족 자녀 방문학습지 지원 신청서 Application for Visiting Tutorial Support 2025

접수번호 Registration No. (to be filled up by the center)			(센터작성)		접수일시 Registration Date (to be filled up by the center)		(센터작성)
보호자 (결혼이민자) Guardian (Marriage immigrant)	이 름 Name		※ 개명했을 경우 개명 전 이름도 필수 기재		주민등록번호 (외국인등록번호) Resident Registration No. (Alien Registration No.)
	연 락 처 Contact No.				출신 국적 Guardian’s Nationality
	주 소 Address
대상자 (자녀) Child	1) 이 름 Name		(girl, boy)			생년월일
	학 교 명 (유치원명) Child’s School		(grade)			선택과목	□ Korean alphabet □ Korean language
	2) 이 름 Name		(girl, boy)			생년월일
	학 교 명 (유치원명) Child’s School		(grade)			선택과목	□ Korean alphabet □ Korean language
신청자 공통서류 : 주민등록등본 / 우선순위 해당자 : 주민등록등본 + 추가서류 Applicants’ Common Documents for submission : Resident Registration Certificate / Those who belong to the priority list : Resident Registration Certificate + Additional Documents
우선순위 선정 해당사항 (□에 V해주세요) Check the corresponding priority list.		우선순위 해당자는 신청 시 추가서류를 함께 제출 필수 After verification please check V the box □ resident registration certificate(required) and the additional documents(for corresponding family) then submit.
		경제상황 Financial Situation		□ 기초생활수급(추가서류:수급자 증명서) Recipient of National Basic Livelihood Security (Recipient Certificate) □ 차상위(추가서류:차상위계층 증명서) Children of low-income earner multicultural family (Low-income earner certificate) □ 해당없음 Not Applicable.
		가족구성 Family Composition		□ 한부모가정 (추가서류:한부모가족 증명서 또는 가족관계 증명서) Single Parent Family (Single Parent Certificate or Family Relations Certificate) □ 조손가정 (추가서류:가족관계 증명서) Grandparents Family □ 부모 또는 자녀가 장애인 등급 등록 (추가서류 : 가족관계 증명서, 장애인등록 증명서) children of multicultural family whose parents or children are registered as disabled (Disability Certificate, Family Relations Certificate) □ 다자녀가정 (2자녀 이상) (자녀수: 명) (추가서류:가족관계 증명서) Family with multiple children(more than 2 children) (Family Relations Certificate) □ 해당없음 Not Applicable.
		수혜여부		□ 2024년도 방문학습지 이용자 (이용기간 : 월 일부터 월 일까지) Recipient of 2024 Visiting Tutorial (Duration : month day to month day) □ 2025년도 신규신청 2025 New Applicant
개인정보수집 및 이용 동의 Consent to Use and Collection of Personal Information		1. Personal Information Item for Collection : information that is submitted above 2. Collection Purpose : Objective data for selecting the target, educational guidance, and utilization of satisfaction survey 3. Duration of Possession‧Use : eradicate when the purpose of collection and use is achieved □ I agree to the above “Collection and Use of Personal Information” and verify its content.
만족도 등 설문 참여 동의 Consent to Participate on the Satisfactory Survey etc.		□ I give my consent to satisfaction survey participation etc.
참고사항 Program Information & Precautionary matters		1. Applicants’ Common Documents for submission : Resident Registration Certificate 2. Personal expenses of the Learner: W3,000 per month 3. If the schedule is violated for more than 3 times without prior agreement with the teacher, the tutorial support might be suspended. 4. If the guardian would not sign the activity report by the visiting teacher without any reason, the tutorial support might be suspended.
I apply for the 2025 Visiting Tutorial for Multicultural Family Children. 2025 Year Month Day Applicant(Married Migrant) Name (signature) 의왕시가족센터 귀하