Japan Cultural Camp by AYFN

Kyoto, Japan
12 17 March 2017
Please insert
photo
here

APPLICATION FORM
Please complete in English.
The information you provide in this form will be used solely for the purpose of this
program. Please, send back this application form along with scanned of Identity card
and financial statement.

1. PERSONAL INFORMATION
Last name
First name
Name shown on
passport
Type of participation

( ) New
( ) Alumni of previous AYFN Program

Nationality
Date of birth
(DD/MM/YYYY)
Place of birth
Sex

( ) Male
( ) Female

Current address
Phone number
(including country code)

Email addresses

(Main Email)
(Alternative Email)

If you are student,

please specify the
name of your school
and your major, year
of entrance
Organization where
you involve
Position or role in
this organization
Website of the
organization
English language
proficiency

( ) Excellent ( ) Good ( ) Fair

Allergy
T Shirt Size

( ) Small ( ) Medium ( ) Large ( ) Extra Large

(Normal Indonesian size)

2. TRAVEL INFORMATION (If you currently hold a valid passport, please

provide information below. If you dont have any yet, please write N/A) and you
still can apply this program.
Passport number
Country which issued
your passport
Date of issue
(DD/MM/YY)
Expiry date
(DD/MM/YY)
3. QUESTIONS
Q1: Please describe your personal information related to yourself,
your daily activity, your talent, etc. (300 words)

Q2: Why do you wish to take part in this Japan Cultural Camp by
AYFN? How would you contribute to its success? (min 150 words)

Q3: This program is SELF FUNDED program. So, who will financially
support you to take part at this program?

Fee option:
( ) Program fee only
( ) All in = Program fee + Flight Ticket
Q4: Please specify the kind of commitment you are ready to make in
order to advance program after 2016.
3

4. Essay
In what ways do you think youth can be a driving force for action in
better world? (min 300 words)