JF & TIFF Lounge

Asian Film Students Exchange Program

Entry Application Form
Directions: Please fill in all blanks

1. Personal data
Family Name（氏） Last Name（名）
Name
（漢字） （漢字）
氏名
Raphael Asadel Ananda
Attach your photo here Date of dd/mm/yyyy Age Gender
写真貼付 20 male
Birth
31/03/2003 年齢 性別
生年月日
Country of
Birth Indonesia Citizenship　国籍 Indonesia
出身国
Home Perumahan Taman Kencana Blok D3/27, RT/001, RW/014, Tegal Alur, Kalideres
Address
Contact Information 現住所
連絡先 Mobile (+62)8119883339 Telephone (+62)8119883339
携帯電話 自宅電話
E-mail ananda.raphael@gmail.com Facebook none
Name Ika Yuliani
Relationship
Mother
Emergency Contact 氏名 ご関係
緊急連絡先 Telephone
(+62)85720196063 E-mail andrian.ananda@gmail.com
電話番号

Name of Institution/University　学校名 Major　専攻 Film

（JP） Faculty　学部 Art and design
Information about （ENG）Multimedia Nusantara University Grade　学年 3.55
Affiliation / University
Address　住所 Telephone (+62-21) 54220808
所属学校
Jalan Scientia Boulevard Gading, Curug Sangereng, Serpong, Fax (+62-21) 5422.0800
Kabupaten Tangerang, Banten 15810 E-mail marketing@umn.ac.id
English Proficiency Certification (if any) English Speaking Level
Language Proficiency 認定スコア・資格（あれば） 英会話レベル
語学力
Type Score ( ) Fluent ( X ) Fair ( ) Poor

Briefly explain about

Asset and environment making in 3D had always been my passion. Since I exposed myself to Disney
your study and area(s) of
interests films early on, I have always wanted to learn 3D Animation. My studies centers on 3D Animation. Thus,
専攻分野・関心のある分野 I am learning my best sculpting 3D Character to leap even further.
など

Are there any matters in your present health condition that should be reported before you travel abroad, such as
chronic disease, allergies, injury, pregnancy, mental or physical disroder diagnosed by a physician, or any other health
Self-assessment of conditions? If yes, please provide details.
health conditions
健康面で注意が
必要な事項 None

Please list any food allergies or dietary restrictions you have.

Food allergies and *We will do our best to accommodate any needs you have in this regard.
dietary restrictons
食物アレルギー
I am Allergic to unfresh food
・食事制限等

Explain about yourself, I am a very adventurous person when it comes to learning. I began learning 3D Modelling when I was
including your 12 and instantly fell in love with it. Thus, I am pursuing my studies in 3D Animation. I do not know
background and when to stop when it comes to visualizing my creative ideas onto my 3D art. I enjoy developing my art
personality since the wait is always worth my time.
What do you expect to To expand my relations and seeking future job opportunities. My dream is to live and work in Japan
this program? Explain ever since I was a kid. I also wish to experience Japanese culture since I never really went to Japan. In
your motivation for this program, I would love to learn deeper about film and animation studies even further and also
applying. befriends fellow future filmmakers.

Overseas Travel /
Study Experience (if I had visited China to explore my Chinese lineage and experience the first-hand culture.
any)

2. Filmmaking
Filmmaking experience 1) Have you ever participated in a film production? ●YES 　　　□NO

Film Title: [Chrysalis] Your role: [Environment design & Sound Engineer]

Production [https://drive.google.com/file/d/1iZ2tGbo33gz3ls
Sample of works [2022] Screener Link (if any):
Year: utqjYWChzst5ZU98pp/view]
(if any)
*Up to two films Film Title: [ ] Your role: [ ]

Production
[ ] Screener Link (if any): [http:// ]
Year:

Films or directors that

have influenced your I really love the way Spider-Man: Across the Spider-Verse animate their animation with varies animation style and
creativity their animation frame rate changes throughout the film, in each character have their style and story into it.
(if any)

Briefly explain about

Production had always been my passion. As I mentioned before, 3D modelling and sculpting is my area
your career plan in
of expertise. Though I am still learning, I would love to become a very talented and versatile 3D artist.
Film/TV field

Handling of Personal Information

By submitting this application form, you concent to the privacy policy below;

1. The Japan Foundation will use the acquired personal information for screening, notification of screening results, implementation
of the project (including the travel arrangement), post-evaluation, communication to successful applicants and for any and all other
purposes for management of applicants and successful applicants).The Japan Foundation will handle the Personal Information of
the Users for the period necessary to achieve the Purposes of Use stated above.

2. The Japan Foundation may provide the Personal Information acquired from the applicants to the following organizations, to the
minimum extent necessary. The Japan Foundation will make sure that the recipients take measures to ensure the security of the
Personal Information.
(1)The Ministry of Foreign Affairs of Japan, Embassies or Consulates-General of Japan, etc. (for support for project implementation)
(2)Other organizations and individuals who receive the information as needed for the projects (including but not limited to travel
agencies in charge of the travel arrangements of the successful applicants)

I hereby certify that all the information given above is nothing but the truth.

Raphael Asadel Ananda

Signature* Date 03/09/2023

(* If you are submitting this form by email, paste electric image of your signature in case that it is not possible, just type your name.)