Application Form (Participants)

Please note that all fields with asterisk* are compulsory.Should you have any queries, please feel free to contact our Participant Services Officers at

ps@ayltlc.com

Asian Youth LeadersTravel and Learning Camp 2014

A. Personal Information (Please write in BLOCK letters)

Name (as in Passport)* Last Name (Surname) *      

      First Name *      

Date of Birth * (DD/MM/YY)    /    /    Gender*

Nationality*      

Passport No*      

Country of Issue*      

Date of Expiry* (DD/MM/YY) :    /    /   

B. Contact Information

Email*      Contact Number *(Country Code – Area Code – Phone Number)

     

Mailing Address (Line 1) *      

Mailing Address (Line 2)      

Zip/Postal Code*       Country*      

Emergency Contact Person*       Relationship with

Applicant*      

Emergency Contact Number*(Country Code – Area Code – Phone Number)

     

Asian Youth LeadersTravel and Learning Camp 2014

C. Health Declaration (For statistical purposes only and not as selection criteria)

Allergies*      

Major Medical Problems*      

Medication Currently Taken*      

Dietary requirements (Halal, vegetarian etc)      

Others      

D. Educational Background

University/School Name*      

Degree/Diploma/Other Qualifications      

Year of Study*      

E. Knowledge of Languages

Please select (X) to indicate your English proficiency with 1 being lowest and 6 being highest.

English*

1 2 3 4 5 6

Native Language      

Asian Youth LeadersTravel and Learning Camp 2014

F. Family Particulars

Family Member 1*

Name*       Relationship with Applicant*      

Occupation*      Contact Number*(Country Code – Area Code – Phone Number)

     

Family Member 2*

Name*       Relationship with Applicant*      

Occupation*      Contact Number*(Country Code – Area Code – Phone Number)

     

G. Experiences/Achievements

Co-curricular Activities (eg. Clubs or Societies, Sports, Performing Arts)

     

Hobbies and Areas of Interest

     

Asian Youth LeadersTravel and Learning Camp 2014

Previous and/or current participation in community / volunteering service, if any (please describe briefly)

     

Awards/Scholarships (if any)

     

Other experiences (if any)

     

Asian Youth LeadersTravel and Learning Camp 2014

H. Personal Statements

Please answer the following questions in no more than 20 0 words each.

Why do you want to apply AYLTLC 2014? *

     

Tell us about an achievement that you are most proud of. *

     

Tell us about a challenge you have faced as a student leader and how you overcame it *

     

Asian Youth LeadersTravel and Learning Camp 2014

Declaration

I hereby declare that the particulars provided are true to the best of my knowledge and that I have not willfully suppressed any material facts. I understand that misrepresentation or omission of any

materials required in this form will be sufficient cause to terminate my position if I have been chosen. I authorize you, your subsidiaries and affiliates, and your authorized agents, to verify all

information contained in this application and any supplement hereto.

(Please insert your signature image here)

Signature: Date (DD/MM/YY)    /    /   

Required DocumentPlease attach and send all the required documents listed below to: register@ayltlc.com. The subject line must be in the format of: Your Name _Country_ Application for AYLTLC 2014. Please ensure that all documents are submitted at the same time so as to prevent any confusion in processing your application. Please also ensure that you submit your forms and pay registration fee before the deadline.

1. AYLTLC 2014 Application Form with signature (in Word.doc format only)

2. AYLTLC 2014 Indemnity Form with signature

3. Scanned copy of your passport (clearly showing your photo and page of particulars)

4. Copy of your Certificate of Participation (Only for Alumni of Global Youth Leaders Travel and Learning Camp or Asian Youth Leaders Travel and Learning Camp)