Entry Form for JENESYS 2.

0
Science and Technology ( 8th Batch)
1. Personal Information

* Please fill in the form in BLOCK LETTERS in English.

Full Name (Exactly the same as your passport)

Name
Photo
(taken within 3
months)
Please write
your
name on the
back of your
photo.

IZZUR ROZABI

Given name (English)

Middle Name (if any)(English)

Family Name (English)

ROZABI

IZZUR

Nickname (Please specify

Full Name (in Mother language)

the name you would like to be called)

IZZUR ROZABI

Date of Birth

12/02/1991

Nationality

INDONESIA

Religion

IZZUR

Age (as of the

day of the flight to
Japan)

Sex

Christian (Roman Catholic Protestant

MuslimOthers
(

Buddhist
Hindu

Mother Tongue

INDONESIAN LANGUANGE

23 YEARS OLD
MF

Other)

SingleMarried

Marital Status

Type of Passport

Number

Private

A 4653051
Passport**

Reg.No.

Date of Issue
28

01

2013

Date of Expiry
28

Diplomat
01

Official
2018

Address
JALAN UNTUNG SURAPATI 63, RT 001/ RW 002, PASURUAN , JAWA TIMUR

Current Address

Tel

Contact Person
inEmergency
*It shall be your parent.
*If you live with him/her,
please leave address
blank.

*If you do not have

phone at your current
address, please write

Fax -

Mobile 083xxxxxxxxx
Full Name
ABDUL CHAMID

E-mail : IZZURxxx@xxx.COM

Tel

Fax -

Relationship

PARENTS
Address
JALAN UNTUNG SURAPATI 63, RT 001/ RW 002, PASURUAN , JAWA TIMUR
-

Mobile

081xxxxxxxxx

E-mail

Profession/Occupation : ENTREPRENEUR
Name
Phone Number
ABDUL CHAMID

081216613627

E-mail
-

contact person and

**Passport: If you have a valid passport, please fill in the passport section. If you don't have a passport, please leave the section blank

Japan International Cooperation Center EF ver.2(April 9, 2013)

2.Health Condition

* Please fill in the form in BLOCK LETTERS in English

Blood Type

A B OAB

don't-know

Good
Previously diagnosed disease:
(
Health Condition

Medicine

Pregnancy

Having Chronic disease:

chronic lung disease (asthma, chronic obstructive lung disease etc.)
immunodeficiency state (T cell immunodeficiency etc.)
chronic heart disease (congenital heart disease, coronary artery disease etc.)
metabolic disease (diabetes) renal dysfunction obesitymyasthenia gravis
others (
)
Not taking any medicines
Taking medicines regularlly (Specified

Yes No

Food Allergies
(only for physical
reason)

none

Food Restriction
(for religion or
custom reason)

pork

pork

beef

fish egg
none

mutton/lamb

shrimp

crabshellfish

others (

beef

fish egg

chicken

chicken

mutton/lamb

shrimp

crabshellfish

others (

*Please be noted that the meals provided in the programme cannot meet all the requests from the participants.

Other Allergies and none

Restriction

dogs

cats

house dust others (

3. Academic Details

)
* Please fill in the form in BLOCK LETTERS in English

Name of School or Organization

Location: (city,province)

BRAWIJAYA UNIVERSITY

MALANG CITY, EAST JAVA

Field of study(for university student only)

Information of your
ECONOMIC DEVELOPMENT
School/Organization
Grade/school year (for student)

4th

as of the day of the flight to Japan

Title (for supervisor only)

English Proficiency

0341573944
Fax:

TOEFL)

Level of English

Level of Japanese

Speaking: Good

Speaking: Poor

Writing :

Writing :

Good

Reading : GOOD
Other Language

TEST OF ENGLISH FOR INTERNATIONAL

COMMUNICATION (TOEIC) : 385 (isi seadanya, karena
bukan pertimbangan khusus)

certificated score (if any, e.g.

Language

Tel:

Poor

Reading : Poor
ARABIC,
JAVANESE

Japan International Cooperation Center EF ver.2(April 9, 2013)

Japanese Year or Month

learning
experience

Center For Islamic

* Please fill in the form in BLOCK LETTERS in English

4. Personal Activities
Economis Studies
Faculty of Economics
Sports/Clubs

and Business

Activities

Staff Of HRD

Period of
Involvement

2010-2014

University Of
Brawijaya
Student Association of
Economic Development
Faculty of Economics and
Business University Of

Staff Of Eksternal
Division

2010-2011

Brawijaya
LSO RISTEK EM UB

Staff HRD

2010-2011

Unitas RKIM UB

Manajer HRD

2011-2012

Unitas RKIM UB

Director

2012-2013

Networking and

MITI KM

Patrnership

2013-2014

INDONESIAN MUSLIM UNITY

STUDENT ACTIONof

Public Policy

2010-2014

UNIVERSITY OF BRAWIJAYA

Hobbies

READING BOOK, WRITING BOOK, AND PUBLIC SPEAKING

Finalis

Academic Awards PKM-GT Krima

Local

2010

1st

Local

2010

3rd

Local

2010

Local

2010

Local

2011

15th

(if any)

Of

2010-2014

Business plan competition

2010 let your mind guide
your future
PKM-GT Maba Level Of
Faculty
Business

Funding

Grants

OfMandiri Bank
PKM-GT Maba Level OF
University

Indonesian

Student

Entrepreneurship
create

and

Award Finalis

Of

National

2011

National

2011

1st

National

2011

1st

National

2011

Regional East Java

2011

IT 10th

make

different
Indonesian Bussiness Expo
and

Competition

(IBEC) 3rd

2011
LKTI

Accounting

Days

2011
Best

Paper

di

Sector

Education Call For Paper

SimposiumNasionalKepemu
daan (IPB 2011)

Wismilak Diplomat Session FinalisOf

50th

II Regional Surabaya
Creative

Business

Plan

Management Event 2011

Participant National

Cerpen Para PencariTuhan Champion

National

2011

Of Hope 1st

di Jepang

2011

Writing

Competition on Indonesia- Finalis

National

2011

International

2011

International

2011

Marocco
International Conference
Faculty of Economic and
Business

Speaker
Coordinato

International Conference
Sharia Economics Event
South East Asia

r Of The
Marketing
Division

Forum SatyaDaya-ITB Fair

2012
Training RKIM I Spirit to
Accelerate
Training Presentations Of
PKM

Participant National

2012

Staff Event Local

2012

Jury

2012

Local

5. Expectations

* Please fill in the form in BLOCK LETTERS in English

Imitate Samurai Culture in Japan

The figure of a Japanese samurai figures are very fabulous. They are very
disciplined, obedient to the command a leader but still have the strong principle. The
figures are able to give their lives for their leaders, have met with punctuality in others.
The figures were shy, very shy when war came, but they did not participate in it. They
are all samurai warriors in Japan.
Please describe
Discipline and his willingness to risk his life, was a resounding impact on the
your expectation by
outcome in the war. And now, the discipline to bring them into the human history is not
participating in this
forgotten. Which is rooted in the history of world civilization. History of the Samurai is
programme.

a very difficult history to be forgotten any age thereafter. Their history is always
inspiring.
Learning from the Japanese samurai is one of the objectives of joining in this
program. Because of the impact of the Japanese samurai that is the generation of today.
When we look at Japan's highly developed and disciplined, it can be ascertained that all
the fruit of the previous generation.
Reflecting on the figures samurai in Japan. They are a very high-minded people
and have a very deep tranquility. In connection with the soul, in the tradition of samurai
to find peace of mind, they prefer to seek peace through meditation. Imprison ourselves,
silent, and calm the mind through meditation, will produce a very deep peace of mind,
clarity in thinking. They will get a clarity in thinking, calmness in the act, and the like
advantages.
Related Learning a clarity in thinking, the Japanese are things that can not be
liberated from a culture that is very rooted. Write down the Japanese culture such as
peace of mind and calm the mind, and is written in a book that is read by the people of
Indonesia is one way to popularize the Japanese in Indonesia.
Gradually, the tradition of Japanese samurai were originally just as a waiter, the
longer the fade when they create groups that eventually became a professional group of
knights. The presence of those who are able to live independently makes them seek to
take away the powers held by the other leaders. Due to power, they each took it
willingly. They compete with each other to grab the front of the image of Japanese
society. Fight to determine who is the most powerful force. One example happened to
the samurai class professionals, the Minamoto clan launched an offensive to seize
power Taira family. In fact they did a very fabulous sea battle in Dannoura which was
eventually won by the Minamoto clan.
That is the lesson that if a Japanese samurai applied in Indonesia should be
eliminated. There is a culture that must be implemented, some are selected so that the
negative is able to be learned. For Indonesian culture, to take lessons from both
Japanese culture lessons in the field of the samurai is the professional attitude of the
samurai. It is probable that the samurai who rebelled not because they wanted more
positions, but they were let down by the current government.
In strata samurai in Japan, the higher the degree of a samurai, then he has a duty
to carry out science science samurai sword more than usual. They studied a lot of
literature, poetry, calligraphy, painting, and ceramic art. For them, according to Boye,
the higher the level of the samurai, the more important it is to study the sciences.
Samurai eliminate the existence of strata and explore the science disciplines
beyond the war began in 1467 AD Since the samurai victories in 794 AD they realized
the importance of learning science outside of the war in 1467 AD.
Sure enough the Japanese are very experienced in the country's progress. The
rapid progress because of how the scientific community will appreciate. Even in the
Japanese culture in these modern times, really appreciate people who have the
knowledge, they used to call 'sensei', or a person who acquired the title 'professor'.
Letter from professor likened powerful letters that can not be denied.

6. Other Information

* Please fill in the form in BLOCK LETTERS in Englis

Have you ever been to Japan before?

Yes

If Yes, what was the purpose of the visit

and where did you visit?

If Yes, When?

16-21/03/2013

Educational Trip

*In principle, any candidates who have participated in JENESYS 2.0 before are not allowed to take part again.

Declaration
I hereby certify that the statements made by me in this form are true and correct to the best of my knowledge.

Signature:

Date:

/ /2014

Agreement of the Application Guidelines for JENESYS2.0

I hereby agree to all the qualifications written in the Application Guidelines for JENESYS2.0.

Signature:

Date: / /2014

Japan International Cooperation Center EF ver.2(April 9,

2013)