(Thai):______________

Gender: ____________________Date of Birth:______________________

Age:________________________

CAMBODIAN-THAI EXCHANGE PROGRAM (CTEP)

School/Institution_____________________________________Major/Title__________________________
__

Initiatives of Change Association, Cambodia in

collaboration with Thai Volunteer Service,
___________________________________________Hometown:
___________________________________
Institute of Human rights and
Peace Studies,
Mahidol University
Mobile:____________________ E-mail:__________________________

Contact Address___________________________________________________________________________

Facebook:_____________________

Hobbies: ____________________________Special
skill/talent:_____________________________________
Emergency Contact: Name:_________________ Relation: __________Contact
Number:_________________
Willing to contribute:
(es. ________ $ (o.
Because_________________________________________
Allergies to any food or needy special dietary, please specify:
______________________________________

Health Condition or special care

needed:_______________________________________________________

How do you know about this program?

_________________________________________________________
Do you have a passport? (Ys

(N

Do you have your own travel insurance? If yes, what company? If no, please inform us.
_________________________________________________________________________________________

CAMBODIAN-THAI EXCHANGE PROGRAM (CTEP)

Initiatives of Change Association, Cambodia in

collaboration with Thai Volunteer Service,
Institute of Human rights and Peace Studies,
Mahidol University

1) What are your motivations to apply this youth exchange program? Why are you
interested to join?
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
______________________________________________________________________________
2) What is your expectation from attending this program?
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
______________________________________________________________________________

3) What do you personally think about the conflict between Thailand and
Cambodia?CAMBODIAN-THAI EXCHANGE PROGRAM (CTEP)

Initiatives of Change Association, Cambodia in

__________________________________________________________________________________
collaboration with Thai Volunteer Service,
__________________________________________________________________________________
Institute of Human rights and Peace Studies,
__________________________________________________________________________________
Mahidol University
______________________________________________________________________________
4) What are your opinions about Cambodia and Khmer people?
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
______________________________________________________________________________
5) As youth, what would you do to strengthen our Thai-Cambodian relation?
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
______________________________________________________________________________

6) Please describe your personality i.e. what you like and dislike, what you
consider as your strong points and your weak points in human relations.

_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________

_____________________________________________________________
___________________________________________________________
CAMBODIAN-THAI
EXCHANGE
PROGRAM
7) If you have
ever been to Cambodia
before, please
share your (CTEP)
thoughts/impressions
towards
what youAssociation,
have experienced. If Cambodia
you have not, but in
Initiatives of
Change
youvecollaboration
been to other Mekong/with
countries,
please
also share your ideas.
And if you
Thai
Volunteer
Service,
haveInstitute
not been to any
mentioned
above,
just skip
to question
no. 8.
ofcountries
Human
rights
and
Peace
Studies,

Mahidol University

_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
___________________________________________________________
8) If you have been selected to be one of the participants of this youth exchange
program, what would be your possible contribution after attending the program?

_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
___________________________________________________________

CAMBODIAN-THAI EXCHANGE PROGRAM (CTEP)

Initiatives of Change Association, Cambodia in

collaboration with Thai Volunteer Service,
Institute of Human rights and Peace Studies,
Mahidol University

PARTICIPANTS PROMISE: To make camp more successful I will abide by

will be at all activities on time and ready to participate. I will be courteous, kind
and respectful of other persons and their possessions. Camp policy prohibits the
use of tobacco, alcohol, and illegal drugs on the campgrounds. (Failure to meet
CAMBODIAN-THAI EXCHANGE PROGRAM (CTEP)
this policy will result in the Camper being sent home at the expense of him/her.

Initiatives of Change Association, Cambodia in

collaboration with Thai Volunteer Service,
Institute of Human rights and Peace Studies,
Campers signature________________________________
Mahidol University
Date________________

CAMBODIAN-THAI EXCHANGE PROGRAM (CTEP)

Initiatives of Change Association, Cambodia in

collaboration with Thai Volunteer Service,
Institute of Human rights and Peace Studies,
Mahidol University

For more detail please contact:

CTEP Coordinators
1- Ms. Jaruwan Supolrai (Netting)
Phone: +66(0)810722714
Email: netting2005@gmail.com
Mrs. Saksinee Emasiri Thanakulmas (Ying)
Phone:+66 (0) 852121980

Email:
HYPERLINK "mailto:yingbangkok@gmail.com" \t "_blank"yingbangkok@gmail.co
Please submit your resume and completed application form in
PDF format to ctep.program@gmail.com.

Before 31th

Au

gust 2012.