Application for Hope and Dreams (HANDs) Project

For University Students

Directions: Please type or print clearly, and fill in all blanks.

Deadline: Completed application form and other supporting documents must be submitted to HAN
Indonesia Secretariat, by 12:00 noon (WIB), Wednesday, August 13, 2014 by e-mail
Name
Attach your photo
here

Date of
Birth

First Name

dd/mm/yyyy

Country
of Birth

Contact
Information

Middle Name

Age (as of
Aug. 31,
2014)
Citizenship

Current
Home
Address
Mobile

Telephone

University or Graduate School

E-mail
Major
Faculty
Batch

Information about
Affiliation

Address

Telephone
Fax
E-mail

Prefered Address
Language
Proficiency

How did you learn

about Hope and
Dreams (HANDs)
Program?

Oversea Travel /
Study Experience
(if any)

Please indicate which address you would like to use for correspond
( ) at home ( ) at university
English Proficiency Certification (if any)
Type

Score

English Level
( ) Fluent ( ) Fair

Oversea Travel /
Study Experience
(if any)

Briefly explain
about yourself,
including your
background,
personality, as
well as your
volunteer /
internship /
professional
experience (750
words maximum)

Briefly explain
about your
experience in
disaster-related
activities (500
words maximum)

Briefly explain
about your
motivation in
joining HANDs
Program. Why do
you think you
should be
selected? (750
words maximum)

about your
motivation in
joining HANDs
Program. Why do
you think you
should be
selected? (750
words maximum)

In the HANDs Program 2014, the participants are expected to create a disaster education re
program as a group, that will be implemented in 2015. Please explain your ideas about disaster
related program that will benefit local communities and that you would like to create. Please s
your target population, 2) knowledge to be used, and 3) how to transfer/convey/communicate i
tell us how you will contribute in realizing the project. Be creative! (750 words maximum

I hereby certify that all the information given above is nothing but the truth.

Signature*

Date

(* If you are submitting this form by email, paste electric image of your signature in case that it is n
possible, just type your name.)

(* If you are submitting this form by email, paste electric image of your signature in case that it is n
possible, just type your name.)

Please attach to this application form the following documents

1. Curriculum Vitae in English. This must not exceed 5 pages in length.
2.Any additional materials about your disaster related activities

ANDs) Projects
s

must be submitted to HANDs

by e-mail
Family Name

( )M

Sex

( )F

e to use for correspondence:

ersity
English Level

( ) Fluent ( ) Fair

( ) Poor

a disaster education related

ur ideas about disaster education
like to create. Please specify 1)
r/convey/communicate it. Please
ve! (750 words maximum)

nature in case that it is not