Professional Documents
Culture Documents
Ship for South-East Asian Youth Program (SSEAYP) ASEAN – Japan (20-30 Attach a 4x6 size
years old) recent
color photograph
here
Indonesia - Malaysia Youth Exchange Program (23-27 years old)
If there is a chance, i am willing to follow any program beyond programs mentioned above
( YES /NO)
1. PERSONAL DATA
Full Name :
Address :
Gender :
Tel (home) :
E-mail :
Interests / hobbies :
5. FOREIGN-LANGUAGE SKILL
Items Spoken Written
□ poor □ poor
□ fair □ fair
□ excellent □ excellent
□ poor □ poor
□ fair □ fair
□ excellent □ excellent
Other (please specify) □ poor □ poor
□ fair □ fair
□ excellent □ excellent
DECLARATION OF AUTHORIZATION
I certify that the statements made by me to the questions above are true, complete, and correct to the
best of my knowledge and belief. Permission is given to the selection committee to make such
investigations if necessary on the information given above. I understand that any misrepresentation or
material omission made herein or in any other documents may lead but not limited to termination or
dismissal of the program.
Full name :
Date of application :
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b. A scan picture of applicant’s ID Card (KTP), file size less than 150 Kb
c. Assignments