Application for

Indonesian Vietnamese Youth Friendship Program

Batch October 2013
1 6 October, 2013
Please complete the application form and save the document as
(yourname)_app.doc, and submit the form to ivyfp.ayfn@gmail.com
___________________________________________________________________________
PERSONAL PARTICULARS
First Name
Last name/ Surname
Date of Birthday
Gender
Nationality
Country of residence
T Shirt size
Passport number. (if any)
Passport expire date (If Any)
1.1 CONTACT INFORMATION
Mailing Adress

MALE

FEMALE

Color Photo Here

Residence address
Mobile phone number
Email
EDUCATIONAL INFORMATION
University/College/School
Academic Year
Field of study
LANGUAGE PROFICIENCY
Indicate your writing ability: No, Basic, Fluent, or Native.
Indicate your speaking ability: No, Basic, Conversational, or Native.

LANGUAGE

WRITING

SPEAKING

Example: English

Native

Native

Basic

Conversational

Example: Chinese

EXTRACURRICULAR ACHIEVEMENTS
List down your extracurricular participations and achievements in University
and High school, with latest on the top.

EXTRACURRICULAR ACTIVITY
Example: Working with
universitys
Entrepreneurship Society.

POSITON HELD
Global Project
Lead

YEAR
2011-2012

HAVE YOU PARTICIPATED IN ANY OVERSEAS EXCHANGE PROGRAM

BEFORE?
List down all the programs that you took part in with year of participation.

NAME OF THE PROGRAM

Example: ILFriP

YEAR OF PARTICIPATION
2010

PERSONAL STATEMENT
1.7.1 Please tell us about yourself, your study, your family, future plan and your dream
(min 300 words)

1.7.2 Why should we accept you? Why would you take part at IVYFP . (In no more than
300 words)

1.7.3 Please write down about your opinion on ASEAN Community 2015. (In no min 250
words)

GENERAL
PLEASE DESCRIBE ANY SPECIAL DIETARY REQUIREMENTS IF NEEDED.
PLEASE STATE YOUR BLOOD TYPE.

INDEMNITY FORM
I, ______________________________, hereby declare that I am participating in
the Indonesian Vietnamese Youth Friendship Program in Ho Chi Minh City
of my own free will and volition, having understood the risks involved in
the above mentioned activity. I shall not hold the organizers of the above
mentioned activity, namely the Asean Youth Friendship Network
Indonesia responsible in any way for my death, injury or disability or any
loss or damage whatsoever arising from any cause in connection with the
activity or my participation therein.
SIGNATURE:

DATE:

PARENTAL CONSENT FOR PARTICIPANT BELOW 20 YEARS OLD

I, _________________________________hereby allow my child/ward* to
participate in the above activity, having understood the risks involved in
the above mentioned activity. I understand and agree that I will have no
claim whatsoever and howsoever against the organizers, the Asean
Youth Friendship Network and Indonesia and local organizer for
any injury or loss of any kind including loss of life that my *child/ward may
sustain during the whole period of the above mentioned activity.

SIGNATURE:

DATE:

CONTACT INFORMATION(IN CASE OF EMERGENCY)

FIRST NAME:

MOBILE NO:

SURNAME:

RESIDENTIAL
NO:
ALTERNATIVE
NO:
DATE:

E-MAIL:
SIGNATURE: