Form 2

Curriculum
th

V i t a e <PY>

Participating Youth of The 37 Ship for Southeast Asian Youth Program

Please write clearly in English (block letters, print or type) in order to avoid misreading of handwriting.

Name underline surname Nationality

(as shown in your Passport) TRAN TRONG NGUYEN VIETNAMESE Number B 4241888 Official 16/7/2010 16/7/2020 Female 25/7/1986 Age: 24 (As of Apr.1, 2009) General

Passport

Type Date of Issue

(DD/MM/YYYY)

Date of Expiry
(DD/MM/YYYY)

Sex Date of Birth

(DD/MM/YYYY)

Male

NO 3 KHAM THIEN STREET, DONG DA DISTRICT, HANOI, VIETNAM Address of Residence Home phone : Fax : Mobile phone : +84-989098995 E-mail (Discussion mailing list): lincosin1982@yahoo.com Name (Relationship) : Emergency Contact DO DINH HAO Phone : Mobile phone : 0905466111 Fax : E-mail :

Occupation

Office/School

Address : NO 15 TRAN BINH TRONG STREET, HAI BA TRUNG DISTRICT, HANOI, VIETNAM 1.Employee (private company) 2.Employee (others) 3.Government Official (Ministries and agencies) 4. Teacher 5. Student 6. Others (specify: ) (As of July 1, 2010) Name : MINISTRY OF PUBLIC Phone : SECURITY Mobile phone : Fax: Position : OFFICER Address : NO 15 TRAN BINH TRONG STREET, HAI BA TRUNG

DISTRICT, HANOI, VIETNAM

Religion Allergy Vegetarian Case History and Prescription Drugs Name: NONE
Restricted Foods: NONE (For religious reasons only) Kind/ name of Foods: NONE Kind/ name of the medicine: NONE

Smoking Fish

Yes Egg

No Dairy )

Yes (Restricted Foods: Meat Others (specify: No Case History : NONE

Prescription Drugs : NONE

The information that you provide may be used for the selection and determination of the invitees.

As for the actual invitees, necessary information may be used for 1) the execution of the program and 2) the establishment and maintenance of the network of ex-participants. Further, these information may be provided for the other invitees and those who are concerned with the program for the purpose of 1) and provide for the post-program activities organization (International Youth Exchange Organisation of Japan (IYEO) for the purpose of 2)respectively All data is securely held in accordance with "Act for Protection of Personal Data Held by Administrative Organs".