APPLICATION FORM

HUMAN RIGHTS TRAINING

OPPORTUNITY: AIR
POLLUTION AND ITS IMPACT
TO CHILDREN’S HEALTH
 CURRICULUM VITAE
Human Rights Training Opportunity: Air
Pollution and Its Impact to Children’s
Health
1. Full Name :

2. Nickname : Photo

3x4
3. Sex :

4. Place, Date of Birth :

5. Age :

6. Blood :

7. Mobile Phone :

8. Religion :

9. Language :

10. E-mail :

11. Address :

12. Education

a. Elementary School :

b. Junior High School :

c. Senior High School :

 d. University :

13. Organizational experiences :

Organisasi (Organizations)
Nama Organisasi Jabatan Nama Institusi Periode
Organization’s Name Position Institution Name Period

Kepanitiaan (Committee)
Nama Organisasi Jabatan Nama Institusi Periode
Organization’s Name Position Institution Name Period

Seminar and Training

 Acara Penyelenggara
Event Organizor

14. Achievement :

PRESTASI (Achievement)
Nama Prestasi Periode
Achievement Name Period

(Place, Date)

(Sign)

(Full name of Applicants)

 MOTIVATION LETTER
Motivation Letter
Human Rights Training Opportunity: Air
Pollution and Its Impact to Children’s
Health

Minimal 300 characters, in English or Bahasa Indonesia

(Place, Date)
 (Sign)

(Full name of Applicants)