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Application Form International Youth Exchange - Programme-1 PDF
Application Form International Youth Exchange - Programme-1 PDF
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
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:
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
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
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
i.
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.
Acceptance of applicants :
Signature :
Date
INTERNATIONAL UNIT,
YOUTH DEVELOPMENT DIVISION,
NATIONAL YOUTH AND SPORTS DEPARTMENT,
MINISTRY OF YOUTH AND SPORTS MALAYSIA,
4. Has never been subjected to any disciplinary action by the association or any other agencies.
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.
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
13. The application form of each candidate is to be submitted through the President / Secretary of the respective
14. Not blacklisted by the National Higher Education Fund Corporation (PTPTN).