Indonesian Youth Exchange Program Application Form1

8/11/2019 Indonesian Youth Exchange Program Application Form1

1/6

PEMERINTAH ACEH

DINAS PEMUDA DAN OLAHRAGAJln. Gurami No. 18 Lampriet Telp. (0651) 7555088 Fax. (0651) 7555088

BANDA ACEH

Indonesian Youth Exchange Program

2014 Intake Application Form

1. Personal Details

Proposed program: (tick one of them)

*Denote mandatory fields

Attach a recent

colour photo 4x6

Name*

Gender*

Place of birth* Date of birth* . / ./ .

National identitynumber (KTP)*

Occupation*

2. Contact Details

Address *

Town/city*

State/province* Postal code

Home phone Work phone

Mobile phone*

Email*

Facebook

TwitterBlogs

3. Youth Exchange Applications

Have you previously applied for youth exchange program but were unsuccessful?* Yes No

If yes how many times have you previously applied for Youth Exchange Program*

Heve you previously been interviewed by Youth Exchange Program Committee?* Yes No

If yes which years?*

CanadaSSEAYPKoreaMalaysia Australia


2/6


3/6

2. Name of Organization

Position

Responsibility (describe your responsibilities and activities that have been ever done, max 100

words)

6. Working Experience

1. Name of Institution

Position

Responsibility (describe your responsibilities and activities that have been ever done, max

100 words)


4/6

2. Name of Institution

Position

Responsibility (describe your responsibilities and activities that have been ever done, max 100

words)

7. Supporting Statement

Limit your answers to approximately 400 words per question.

1. Why do you want to attend this Youth Exchange Program?*


5/6

2. Descripe your experience in social activities and what is your role?*

3. Why do you choose this country?*


6/6

4.

What do you plan to do after finishing the program for your community?*

Declaration and acknowledgement

I declare, in submitting this application form, that the informaton contained in it and provided in

connection with is true and correct

Full name Signature Date

__ / __ / ____

Indonesian Youth Exchange Program Application Form1

Documents

Transcript of Indonesian Youth Exchange Program Application Form1