___________________________________________________________________________

Application for
ASEANpreneurs Youth Leaders Exchange (AYLE) 2014
January 2014
Please complete the application form, add in your CV/resume at the end
and save the document as (yourname)_(country)_app.doc, and submit the
form to aseanpreneurs@nes.org.sg
Applications deadline December 11, 2013
___________________________________________________________________________
1.1

1.2

PERSONAL PARTICULARS
FIRST NAME:
LAST NAME / SURNAME:
BIRTHDAY:
GENDER:
COUNTRY OF RESIDENCE:
NATIONALITY:
NRIC / IDENTIFICATION NO:
PASSPORT NO.:
PASSPORT EXPIRY DATE:
CONTACT INFORMATION
MAILING ADDRESS:

MALE

RESIDENTAL ADRESS:

1.3

CONTACT NO*.:
EMAIL:
EDUCATIONAL INFORMATION
UNIVERSITY:
ACADEMIC YEAR:
FIELD OF STUDY:
GPA/CAP:
YEAR OF EXPECTED
GRADUATION:

FEMALE

Photo Here

1.4

LANGUAGE PROFICIENCY

Indicate your writing ability: No, Basic, Fluent, or Native.

Indicate your speaking ability: No, Basic, Conversational, or Native.

LANGUAGE

WRITING

SPEAKING

Example: English

Native

Native

Basic

Conversational

Example: Chinese
1.5

EXTRACURRICULAR ACHIEVEMENTS

List down all your extracurricular participations and achievements in University

and High school, with latest on the top.

EXTRACURRICULAR ACTIVITY
Example: Working with
universitys
Entrepreneurship Society.

POSITON HELD
Global Project
Lead

YEAR
2012

1.7 WHAT ARE YOUR ENTREPRENEURIAL EXPERIENCE

Example includes starting your own business, participated and win a business proposal
competition

1.6 HAVE YOU PARTICIPATED IN ANY OVERSEAS EXCHANGE

PROGRAM BEFORE?
List down all the programs that you took part in with year of participation.

NAME OF THE PROGRAM

Example: AYLE

YEAR OF PARTICIPATION
2012

1.7 PERSONAL STATEMENT

Write about yourself in no more than 300 words, that can help us understand you better

1.8 GENERAL
PLEASE DESCRIBE ANY SPECIAL DIETARY REQUIREMENTS IF NEEDED.
PLEASE DESCRIBE ANY DRUG ALLERGIES AND/OR MEDICAL NEEDS.

PLEASE STATE YOUR BLOOD TYPE.

1.9 SURVEY
HOW DID YOU KNOW ABOUT AYLE 2014?
Please check all that apply
- ASEANPRENEURS WEBSITE
- UNIVERSITY
- TEACHERS/STAFF
- FRIENDS
- ASEANPRENEURS COUNTRY
MANAGERS
WRITE DOWN THE NAME OF THE ASEANPRENEURS COUNTRY
AMBASSADOR (S) WHO APPROACHED YOU FOR PROMOTING AYLE
2014
If you have not been approached by any Country Ambassador in your country
then write: N/A

NAME OF THE COUNTRY AMBASSADOR(S):

2.0

INDEMNITY FORM

I, ______________________________, NRIC / Passport No. ____________________,

hereby declare that I am participating in the ASEANpreneurs Youth
Leaders Exchange 2014 of my own free will and volition, having
understood the risks involved in the above mentioned activity. I shall not
hold the organizers of the above mentioned activity, namely the National
University of Singapore, NUS Entrepreneurship Society and
ASEANpreneurs responsible in any way for my death, injury or disability
or any loss or damage whatsoever arising from any cause in connection
with the activity or my participation therein.
SIGNATURE:

DATE:

2.0 PARENTAL CONSENT FOR PARTICIPANT BELOW 21 YEARS OLD

I, _________________________________, NRIC / Passport No.
_____________________, hereby allow my child/ward*
_________________________________, NRIC / Passport No.
_____________________ to participate in the above activity, having
understood the risks involved in the above mentioned activity. I
understand and agree that I will have no claim whatsoever and howsoever
against the organizers, the National University of Singapore, NUS
Entrepreneurship Society and ASEANpreneurs for any injury or loss
of any kind including loss of life that my *child/ward may sustain during
the whole period of the above mentioned activity.
SIGNATURE:

DATE:

2.1 NEXT OF KIN CONTACT INFORMATION (IN CASE OF

EMERGENCY)
FIRST NAME:
MOBILE NO*:
SURNAME:
E-MAIL:
SIGNATURE:
* include country code

RESIDENTIAL
NO*:
ALTERNATIVE
NO*:
DATE: