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Application Form 2019: International Youth Exchange

[This document is an application form for an international youth exchange program in 2019. It requests personal information such as name, date of birth, nationality, religion, passport details, contact information, health conditions, dietary restrictions, academic or employment details, personal activities, expectations and experiences from previous exchange programs. Applicants are asked to provide a short essay on what they expect from the program and why they want to join. They must declare that the information provided is true and correct. Parental consent is required for applicants under 18.]

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Amii Thaytamii
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0% found this document useful (0 votes)
55 views3 pages

Application Form 2019: International Youth Exchange

[This document is an application form for an international youth exchange program in 2019. It requests personal information such as name, date of birth, nationality, religion, passport details, contact information, health conditions, dietary restrictions, academic or employment details, personal activities, expectations and experiences from previous exchange programs. Applicants are asked to provide a short essay on what they expect from the program and why they want to join. They must declare that the information provided is true and correct. Parental consent is required for applicants under 18.]

Uploaded by

Amii Thaytamii
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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INTERNATIONAL YOUTH EXCHANGE

APPLICATION FORM 2019


1. Personal Information *fill in all columns and sections. Blank columns are not accepted

Photo Full Name (Exactly the same as your passport)


(taken within 3 Name
months)
Please write your
Nickname : (the name you like to be called)
name on the back
of your photo.

Date of Birth (Day) (Month) (Year) Age (as of the


(as shown on your starting day of
passport) the programme)

Nationality Sex Male Femal

Muslim Catholicism Hindusim


Religion
Confucianism Protestatism Buddhism

Mother Tongue Marital Status Single Married

Widowed Divorced
Number Type of Passport
Private Diplomat Official
Passport
Date of Issue Date of Expiry
(Day) (Month) (Year) (Day) (Month) (Year)

Facebook Twitter Instagram Others


Social Media Accounts

Address

Current Address

Tel: Fax:
Mobile: E-mail:
Full Name Relationship

Address
Contact Person
in Emergency
Tel: Fax:
Mobile: E-mail:
Profession/Occupation:
Full Name Relationship
*If you do not have phone
at your current address,
please write contact
person and number. Phone Number: E-mail:
2. Health Condition
Blood Type A B O AB UNKNOWN

Good
□Having Chronic disease
Please specify:
Health Condition
_________________________________________________________________________
_________________________________________________________________________

□Not taking any medicines


Medicine
□Taking medicines regularlly (Specified: )
Food Allergies □None
(which may cause □Shrimp □Crab □Shellfish □Fish □Egg
allergic reaction)
□Others ( )
□None
Food Restriction □Pork □Beef □Chicken □Mutton/Lamb □Shrimp □Crab □Shellfish
(for religion or
custom reason) □Fish □Egg □Others ( )
*Please be noted that the meals provided in the programme cannot meet all the requests from the participants.

Dietary □None
Requirements □Vegitarian □Vegan □Halal □Others ( )
Other Allergies and □None
Restriction □Dogs □Cats □House dust □Others ( )

3. Academic/ Employment Details


Name of School / University / Employer Location (city,province)

Information of your
School/University/ Field of study/ Positions
Employer

English Proficiency
certificated score (if any, e.g. TOEFL)

Level of English
Speaking : Good Fair Poor
Language Writing : Good Fair Poor
Reading : Good Fair Poor
Other
Language

4. Personal Activities
Activities Period of Involvement
Sports/Clubs

Hobbies

Awards
(if any)
5. Essay

What do you expect


from this program ?
(100 words)

Please describe your


self and why do you
want to join this
program ? (250)

6. Exchange Programs Experiences


Have you ever join
youth/student Yes ↓ No, → No need to fill the below
exchange

Name of the program :


If yes, what program
and who provided the
finance?
Finnaced :

If yes, when and


where was the When : ( ) Where : ( )
programs?

If yes, legth of stay?

Declaration
I hereby certify that the filling in and statements by myself in this form are true and correct.
I am fully aware of my responsibilities as participant.
I will follow all of the guidelines given for this activity and will not hold the facilitator or organization responsible
for any untowards incident that i have caused or incured.
(Day) (Month) (Year)

Participant's Signature: Date: / /

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