NATIONAL YOUTH COMMISSION INTERNATIONAL PROGRAM

APPLICATION FORM
Not for Sale May be reproduced
INTERNATIONAL PROGRAM APPLYING FOR:
1. Surname:

_______________________________ 2. Gender: [ M ] [ F ]

First Name: _______________________________ 3. Height: ________

Passport-sized photo

Middle Name: ______________ 4. Weight: ______5. Age:_______________

Nickname: ___________ 6. Birthdate: __________________7. Birthplace: __________________
8. Current Address: ____________________________________________________ 9. Region:____
10. Years of Stay: ________________ 11. Tel. No. (Landline/Area Code):_______________________
12. Zip Code: _____ 13. Email Address: _________________14. Cellphone No: ________________
_______________________
Pls. Indicate date taken

15. Religion: __________________16. Present Occupation/Position: _________________________

17. Name of Office: ________________ 18. Office Address: ________________________________

Date Taken:

19. Years in the Present Work: __________________ 20. Civil Status: _______________________

Passport Details

21. Number

Place of Issue:

22. Type

Official

General

23. Date of Issue

24. Date of Expiry
25. Name (Relationship):
Emergency Contact

27. Phone:
28. Mobile Phone:

26. Address:

29. Fathers Name: Marc Red A. Marinas

Place of Birth: Manila
30. Mothers Name: Rhea A. Magpayo
Place of Birth: Manila
31. No. of Brother/s: 1
32. No. of Sisterr/s: 1
33. Educational Background
Name of School/University
Course / Inclusive Dates
Elementary
South Crest School
2002 - 2008
Secondary
South Crest School
2008 - 2012
Tertiary
University of Perpetual Help
2013 - Present
System DALTA
Vocational
Post Graduate
34. Scholarship Grants
Donor
Inclusive Dates

35. Youth Organization/Youth Serving Organization Affiliations:

Name of Organization
Position
Rotary Interact Club
Member
NFJPIA NCR
Member
JPIA UPHSD
VP for Non-Academic Affairs

Occupation: Immigration Officer

Occupation: Housewife

Honors Received
Salutatorian

Years of Membership
2011-2012
2013-Present
2015-Present

Honors Received

Accomplishments

36. Special Skills or Talents:

37. Food Restrictions:
None
39. Dialect(s) or Foreign Language(s) Spoken:
Filipino and English
40. Title of Seminar/Training Course Attended

41. Previous Work Experience

38. Allergies
None
Inclusive Dates

No. of Hours

Conducted by

Name of Company
University Savings and Loans Bank

42. Character References:

Name

Position
Intern

Inclusive Dates
2015-2016

Salary
None

[not related to you within the third degree of consanguinity]

Occupation

Address and Telephone No.

All facts and data given in this information sheet will be treated with utmost confidentiality
44. Have you previously applied for any NYC International Exchange Program? No

Yes

How many times? ________________

If yes, please indicate the program/s and year/s: ________________________________________________________________________

No

45. Have you been a participant of any NYC International Exchange Program?

Yes

How many times? _______________

If yes, please indicate the program and year: _______________________________________________________________________

46. How did you know about the program?
Facebook: _____

Twitter: ______

Website:

E-mail from NYC: ______

_____

Others [pls. Indicate]: _____________________________________________________

47. Have you availed of any program or scholarship grant offered by any foreign government? [ ] No

[ ] Yes

If yes, please indicate the program, year, and name of organizer

48. Have you attended any seminar, conference or trainings abroad? [ ] No

[ ] Yes

If yes, please indicate the program and year _______________________________________

49. Have you been involved with any NYC local program or activity? [ ] No

[ ] Yes

If yes, please indicate the program(s) and year ______________________________________

50. Have you ever been convicted of any crime involving moral turpitude? [ ] No

[ ] Yes

If yes, please indicate the nature and status

51. Do you have any pending case? [ ] No [ ] Yes
If yes, please indicate the nature and status
STATEMENT
I hereby certify upon my honor that all facts and information indicated herein are true and correct to the best of my knowledge. I further declare that
any information given by me that is untrue may constitute a disqualification to any NYC programs.
The undersigned expressly authorizes the National Youth Commission or its representatives to use, share, and process my personal information I
have provided, shared, or declared in this form for any lawful purpose.
Further, I subscribe and agree that the National Youth Commission has the sole prerogative to select and nominate the delegates to any
International Program, and its decision is final and executory.
IN WITNESS hereof, I am executing and signing this statement voluntarily without compulsion.
_____________________________
Signature
______________________________
Printed Name
NOTE:

The National Youth Commission reserves the right and prerogative to exclude applicants who will not meet the minimum requirements of the
Program. Lack or non-compliance of any of the above stated requirements will mean automatic disqualification without notice.

Mail or hand carry your application to the International Committee, National Youth Commission, 4 th Flr., Bookman Building, 373 Quezon
Avenue, Quezon City, Tel No. 4162833.
Please fill out the form legibly