4th WYA Asia Pacific Emerging Leaders Conference

Redefining Education:
Breaking Barriers, Empowering the Asia Pacific Youth
October 15 to 17, 2015
The BayLeaf Hotel, Manila, Philippines

APPLICATION FORM
Please answer using Block Letters. Incomplete forms shall automatically be disqualified.
Please c heck your application category:

Delegate (Students and Community Youth Leaders)

Educators (Teachers, Professors and Student Organization Advisers)

PART 1: PERSONAL INFORMATION

Last Name:

First Name:

Middle Name:

Nickname:

Sex (Male or Female):

Country of Residence:

Current Address:
Birthdate:

Birthplace:

Age:

Mobile number:

Mobile number:

Telephone number:

Nationality:

Religion:

Languages spoken:

Shirt size:

Special skills or talents:

Hobbies and interests:

PART 2: OCCUPATION (For young professionals or working students)

Present Occupation/Designation:
Name of Office:
Telephone number:

Fax number:

Website:

Years in the Present Work:

PART 3: PASSPORT DETAILS

Passport number:

Type (Official or General):

Date of Issue:

Date of Expiry:

Place of Issue:

PART 4: PARENTS AND EMERGENCY CONTACT

Fathers Name:

Occupation:

Mothers Name:

Occupation:

Emergency Contact Person:

Relationship:

Mobile number:

Telephone number:

Address:

PART 5: EDUCATIONAL BACKGROUND

Name of School

Years Attended

Degree Received

Elementary
Secondary
Tertiary
Vocational
Post Graduate
Others

PART 6: ORGANIZATONAL AFFILIATION (Maximum of ten recent affiliations)

Name of Organization

Designation

Years of membership

Accomplishment

PART 7: Scholarship and Awards (Maximum of three recent scholarships/awards)

Name of Scholarship/Award

Awarding institution

Year awarded

PART 8: Training or Conferences Attended (Maximum of ten recent conferences)

Name of Conference

Organizing Institution

Inclusive Dates

PART 9: Medical Condition, Food Restriction and Special Needs

Allergies:
Food Restrictions:
Special Medication:
Do you have any disabilities? If yes, please specify.

PART 10: English Language Proficiency (Please put an X in the appropriate column)
Excellent

Very Good

Good

Fair

Poor

Speaking
Reading
Writing

PART 11: Additional Information

Are you a World Youth Alliance member? If not, do you want to become a member?

Have you been a participant of the 1st, 2nd and 3rd WYAAP Emerging Leaders Conference?

How did you know about World Youth Alliance?

How did you know about the 4th WYA Asia Pacific Emerging Leaders Conference?

Have you been involved in any WYA regional or international project? If yes, which ones?

PART 12: Statement

I hereby certify upon my honor that all facts and information indicated herein are true and
correct to the best of my knowledge. I further declare any information given by me that is untrue
may constitute a disqualification to the conference. The undersigned expressly authorizes World
Youth Alliance Asia Pacific or its representatives to use, share, and process my personal
information I have provided, shared, or declared in this form for any lawful purposes. Further, I
subscribe and agree that the World Youth Alliance Asia Pacific has the sole prerogative to select
the participants to the conference, and its decision is final and executory. IN WITNESS hereof, I
am executing and signing this statement voluntarily without compulsion.

__________________________________
Signature Above Printed Name

PART 13: Essays

A. Why do you want to join the conference? (100 words or less)

B. What role can the youth play to help address problems related to education? (150 words or less)

C. What are your expectations from this conference? In what way can you contribute to the success of
the 4th World Youth Alliance Asia Pacific Emerging Leaders Conference? (100 words or less)

D. What project initiative do you want to implement when you get back to your school or
community to share your experience and lessons learn from the conference? (150 words or less)

PART 14: World Youth Alliance Charter

The World Youth Alliance is composed of young women and men from every part of the
world. In cooperation with other organs of the international community, primarily the
United Nations and the European Union, the World Youth Alliance is committed to building
free and just societies through a culture of life. That culture affirms the inalienable dignity of
the person, defends the intrinsic right to life, nurtures the family, and fosters a social climate

favorable to integral development, solidarity, and mutual respect.

We recognize that the intrinsic dignity of the person is the foundation of every human right.
We believe this dignity is independent of any individual condition and that no human
community can grant or rescind that dignity.
We are convinced that the intrinsic dignity possessed by every human being from conception
to natural death is the foundation of everyones right to life. We believe that this inalienable
right to life is the basis of a free and just society and we believe that society through law and
culture has an obligation to protect the dignity of the person and thus protect the right to
life.
We affirm that the fundamental unit of human society is the family, where women and men
learn to live in genuine freedom and solidarity, and where individuals are equipped to fulfill
their social obligations. We believe that the political community at the local, national and
international level is obliged to protect and nurture the family.
We believe that the authentic development of society can occur only in a culture that fosters
integral human development characterized by physical, spiritual, mental, and emotional
growth, in a climate of respect for the human person and the family.
We invite all those who share these convictions to join us in affirming them and giving them
effect in public life at all levels.
__________________________________
Signature Above Printed Name

Save your application form either in .PDF or .DOC format. If youre sending your application
through email, dont forget to write in the subject line APPLICATION: (COMPLETE NAME).
Submit your complete application form via e-mail to wyaap.conference@gmail.com or drop
it off/deliver to our office (address below).
For Inquiries: Please contact us via email or through phone +63.2.9215162. You may also
visit our website at www.wya.net/apelc.
Thank you and we look forward to receiving your application soon!

Application Deadline
Early Bird: July 17, 2015 (Friday)
Regular Deadline: August 18, 2015 (Tuesday)
Payment Deadline: September 18, 2015 (Friday)

Conference Fee

Regular Application

Early Bird Application

Local Participant W/O

Accommodations

PhP4,500.00

PhP3,900.00

Local Participant W/
Accommodations

PhP7,000.00

PhP6,400.00

International Participant

USD185.00

USD170.00

*Submit application on or
before August 18, 2015
(Tuesday).

*Submit application on or
before July 17, 2015
(Friday).

*Educators/adult supervisors will be paying the same rate as their students.

All delegate conference fees include conference materials and kit, meals and snacks during
the conference. All other travel, lodging, visa and tax expenses before and after the
conference will be the sole responsibility of the participant.
Payments made are final and non-refundable. This confirms your slot to the conference.