Entry Form

JENESYS2023 ASEAN-Japan Students Conference

※ Choose one from the 5 themes as follows;
【1st Choice】
□ Climate Change and Disaster Prevention □ Tourism Development
□ Startups □ Population Problem □ Internet and AI
【2nd Choice】
□ Climate Change and Disaster Prevention □ Tourism Development
□ Startups □ Population Problem □ Internet and AI

1 Personal Information
Full Name (Exactly the same as your Passport)
English

Name
Full Name (in Mother Language)
Lao

Day/Month/Year
Date of Birth Age
/ /

Nationality Gender Religion

Date of Issue Date of Expiry

Number
Passport Day/Month/Year Day/Month/Year
(If you have)
/ / / /

Address ：

Current Address Tel/Mobile phone ：

E-mail ：

Name of School:
School
Major: School Year：

□ Good □ I have been diagnosed (Name of disease: )

Health Condition
□ Having chronic disease (Name of disease: )

2. Experiences related to Japan

① Have you been to Japan before? YES NO → If "Yes" When and for What?

② Are you a learner of Japanese language? YES NO → If "Yes" How Many Years ?

③ Have you ever joined JENESYS Online

program? YES NO → If "Yes" which program have you joined?

3. Personal Activities

Hobbies/Favorites
 Prizes/Awards
(Sports or Academic, if any)

Social Activities