NATIONAL YOUTH AND SPORTS DEPARTMENT

MINISTRY OF YOUTH AND SPORTS MALAYSIA

PASSPORT
PHOTO

APPLICATION FORM
INTERNATIONAL YOUTH EXCHANGE PROGRAMME
Please ( / ) your preferences in the remark box
NO
PROGRAMME
1
Ship for south East Asia Youth Programme
2
Malaysia-Fukuoka Youth Exchange Programme
3
Malaysia-Indonesia-Malaysia Youth Exchange Programme
4
Malaysia-Korea-Malaysia Youth Exchange Programme
5
Malaysia-Singapore-Malaysia Youth Programme
6
ASEAN Programmes
7
Commonwealth Programmes
8
Invitation Programmes
9
According to the requirement by KBS

AGE
18-29
18-29
18-29
18-29
18-29
18-29
18-29
18-29
30>

REMARK

Please complete all the details with CAPITAL LETTERS

PERSONAL DETAILS:
STATE
NAME
GENDER

MALE
FEMALE

I/C NUMBER
MARITAL STATUS

NATIONALITY
SINGLE
MARRIED

DATE OF BIRTH

RELIGION

PLACE OF BIRTH

AGE

HEIGHT (cm)

WEIGHT (cm)

PASSPORT
DATE OF ISSUE:

EMAIL

DATE OF EXPIRY:
HOME ADDRESS

HOME NUMBER

MOBILE NUMBER
ORGANIZATION DETAILS (For those who are working ):
EMPLOYER
OFFICE ADDRESS

OFFICE NUMBER

FAX NUMBER

OCCUPATION/
POSITION

OFFICER USE

INSTITUTION OF HIGHER LEARNING (For those who are studying)

School / University / College /
Polytechnique
Major:
ADDRESS:

OFFICE NUMBER
FAX NUMBER

POSITION
YOUTH ORGANISATION (For those who registered with any association at the national/state/district level)
YOUTH ORGANISATION /
ASSOCIATION
POSITION

OFFICE ADDRESS

OFFICE NUMBER
FAX NUMBER

YOUTH ORGANISATION / YOUTH & SPORT OFFICER ENDORSEMENT:

This applicant is a member of this organisation since:
Official
Stamp

-------------------------------------------------(President / Secretary / Youth & Sport Officer signature)

ADDITIONAL INFORMATION
LANGUAGE PROFIENCY:
(Please tick ( / ) in the
appropriate boxes)

GOOD
Speaking

INTERMEDIATE
Writing

Speaking

Writing

POOR
Speaking

Writing

MALAY
ENGLISH

Other Languages:
(Please specify)
Restricted Food/Special Dietary
requirements:
Hobbies/Special Skills/Particular
Interests:
PERSONAL REFERENCES (FOR EMERGENCIES)
NAME:

MOBILE NUMBER
HOME NUMBER

RELATIONSHIP:
Have you ever participated in
any international programme/
activity (For the last 3 years?
If yes please specify)
YES

NO

ACTIVITY/PROGRAMME

YEAR

Terms, conditions and Guidelines in

filling the forms:

i.

The International Unit will ACCEPT ONLY ORIGINAL (WITH

OFFICIAL STAMP) and COMPLETED FORMS for further
consideration. Forms that are received via fax / photocopies will be
considered as VOID.

ii.

Please attach along a latest passport size photo (2) when returning
your COMPLETED FORM. The photo should be set on a
blue background, showing head and shoulders only.

iii.

COMPLETED FORMS must be sent to and reach the address

below before or on the CLOSING DATE : 14 FEBRUARY 2016
FORMS RECEIVED LATER THAN THE MENTIONED DATE
WILL NOT BE ENTERTAINED.
INTERNATIONAL UNIT,
YOUTH DEVELOPMENT DIVISION,
NATIONAL YOUTH AND SPORTS DEPARTMENT,
MINISTRY OF YOUTH AND SPORTS MALAYSIA,
LEVEL 11, KBS TOWER, PRECINCT 4,
NO 27, PERSIARAN PERDANA,
62570, PUTRAJAYA.
TEL: 03-88713744/3796/3371
FAX: 03-88888761
(ATTN : EN. KHAIRUL / PN. NURUL SHEEMA / EN. HAFIZAN

All information above is true and if it is

not correct, the ministry has the right not
to consider and to reject my application

Acceptance of applicants :
Signature :
Date

INTERNATIONAL UNIT,
YOUTH DEVELOPMENT DIVISION,
NATIONAL YOUTH AND SPORTS DEPARTMENT,
MINISTRY OF YOUTH AND SPORTS MALAYSIA,

CRITERIA TO APPLY FOR THE INTERNATIONAL YOUTH EXCHANGE PROGRAMME 2016

CONDITIONS AND CRITERIA:

1. Only Malaysians are permitted to apply.

2. Aged between 18 to 29 years old.

3. A member of youth organisation registered under the Registrar of Youth (RoY).

4. Has never been subjected to any disciplinary action by the association or any other agencies.

5. Able to communicate in English proficiently (both spoken and written)

6. Able to participate in the Selection Camp and the Pre-Departure Training (PDT) for each programme offered.

7. Possess elements of creativity and aptitude in the fields of culture and sports.

8. Active in the youth movement within the country as well as internationally.

9. Competitive in nature, but also able to cooperate in a team effectively.

10. Highly disciplined, and portrays the best of the participating contingent as well as the country.

11. Brilliant leadership skills and the ability to carry out responsibilities entrusted effectively.

12. Comply with the directives and standard of ethics as a participant in an international programme as outlined by

the Ministry of Youth and Sports of Malaysia.

13. The application form of each candidate is to be submitted through the President / Secretary of the respective

youth association he/she is part of.

14. Not blacklisted by the National Higher Education Fund Corporation (PTPTN).