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INFORMATION FOR APPLICANTS

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Eligibility
o Age (Parcticipants should not be older than the maximum age and
younger than the minimum age by the time of the program starts) :
- Indonesian Canada Youth Exchange Program (ICYEP): Female, 1823 years old
- Australia Indonesia Youth Exchange Program (AIYEP): Male, 21-25
years old
- Indonesia Malaysia Youth Exchange Program (IMYEP): Male, 23-27
years old
- Ship for South East Asia Youth Program (SSEAYP) : Male, 20-30 years
old
Graduated from Senior High School or higher.
Single (Not married yet).
o Has not joined any abroad youth exchange program under the Ministry
of Youth and Sport of Indonesia.
Requirements
Completely fill the application form.
Attach the following documents with the filled application form:
- A copy of identity card which shows your Bengkulu residentship.
- 2 sheets of recent photographs (passport size /4 cmx6cm)

Note : The requirements should be submitted directly to the committe (hard


copy) on March 26th-27th, 2012. The requirements can be submitted
directly to the committe on those dates at 9.00 a.m 16.00 p.m in
Bagian Kepemudaan, Dinas Pemuda dan Olahraga Provinsi Bengkulu.

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For the selected candidate (If you are selected as the representative
of Bengkulu Province for the respective program, you should submit
the following requirements to Ministry of Youth and Sport) :
Requirements:
Birth certificate.
Letter of permission from parents or home institution (with Rp 6.000
stamp /materai).
Letter of statement signed by Dinas Pemuda dan Olahraga.
Identity card.
Criminal Records (SKCK).
Copy of passport.
Copy of English competency test result (TOEIC / TOEFL/IELTS)
2 sheets of recent photographs (passport size /4 cmx6cm)

A paper (1000 words in minimum) about your activities during and after the
program.
Apply for:

APPLICATION FORM
CANDIDATES OF YOUTH EXCHANGE PROGRAM PARTICIPANTS 2012
Full Name

: Muhammad Nico Permana

Nick Name

: Nico

Sex

: Male

Date of Birth : May 10th, 1992


Address

Your picture

: Jl. Timur Indah 3 RT 2 RW 1 No.108 Sidomulyo, Bengkulu


here

Occupation : Student
Phone Number

: +6287894720026

Email

: nicopermana105@yahoo.co.id

Interests

: Listen to music, Playing Football & Futsal, Browsing Internet

Skills

: Announcing, Playing Guitar

Name
Secretary of Youth Red
Cross in Junior High
School 4 (SMP Negeri 4)
Bengkulu
Cordinator of Eletrician
Communities HIMATRO
University of Bengkulu

Name

Organizational Experiences
Year
Description
2005/2006

2011/2012

Achievement / Awards
Year

Other Experiences

Description

Name
Radio Announcer

Year

Description

Write about yourself in the following box (250 words in minimum):


I have a small posture, with brown skin, straight hair and thin, and foot
disorders from childhood, O-shaped (Latin: genu varum). When asked about
abilities, all I could say its standard, from playing soccer and futsal,
swimming, and badminton. If it for an academic record, I'm not stupid as
seen (said my mom). Proved, with my achievements : rank 1 from grade 1
to 6 at Elementary School. Continues, in the Junior High School ranking
fourth in a row, 5 (grade 7); rank 5, 3 (grade 8) and rank 5, 8 (grade 9).
However, in High school I lost my magic-touch. I have bad-record: never
finish in the top 20! And lastly, I came to College and l became Electrical
Engineering Student in Univversity of Bengkulu ...
I can be proud of myself 'cause fact that I was a radio announcer, one of
these radios in Bengkulu (SwaraUNIB FM). Well, although I'm still newbie and
many deficiencies in all the lines of science of broadcasting, I'm sure that
Write about your motivation to join the progam (250 words in minimum):
I follow this program to convince the world that I still have the ability, not be
ridiculed, and proved that I also bring pride to my parents. In other words, I
just want to recognized as someone to be reckoned with. You can see in the
achievement / award column, I didn't have anything. So I can only hope
from here.
And because I have a dream to see and learn how to be foreign people in
other country, sure I must follow this program.

I hereby state that all information written here is true and Im applying myself to
join the selection process.
Bengkulu, ..................

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