asean-korea youth square akyas manjaniq
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Youth Exchange Programme: ASEAN-Korea Youth Square
Seoul & Gangwon-do, Korea / 5 to 10 February 2015
Please complete t!s "orm based on your passport# $%e t!tle o" e-ma!l sould be 'S(')-Korea*name o" part!c!pant+
Personal Information
First Name: 'yas
P
Last Name: anan!
Full Name (with Middle Initial): 'yas anan!
Gender (Female/Male): ale
Nationality as shown on passport: 3ndones!a
Year of Birth (YYYYMM!!): 1444-01-0
Passport Num"er: 6 007701
- 8ate o" (9p!ry: 27-12-2014
#eli$ion: 3slam
%onta&t Information
%urrent 'ddress: ;euw!anyar street no 2< %as!malaya =!ty, >est ?a@a, 3ndones!a 7A%ity: %as!malaya
%ountry of residen&e: 3ndones!a
%onta&t email:
elephone with &ountry &ode (e$ *++,,,,,,): A2-2A5-11121
Mo"ile with &ountry &ode: A2-B-5BA-1AB-BBB0
'dditional Information
Name of your latest s&hool (or wor-) : ?enderal Soed!rman Cn!@ers!ty Purwoerto
.n$lish profi&ien&y ('dan&ed/Natie): 'd@anced
Preferred tshirt si0e
1pe&ial #e2uests 3 Medi&al %onditions
Prohi"ited food(s): por
'ller$ies to (food4 medi&ine4 plant4 and et&): no
If you are on spe&ial medi&ation4 let us -now:
5hy should you "e sele&ted 6
The 16thASEAN-Korea Future-Oriented
DS / S / / L / D; / DD; / DDD;
mailto:[email protected]:[email protected] -
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ecause a@e an a @en urous sp r , wan o a ways ry an earn new ngs, @ery appy o mee an n erac w peop e wrespects, !nclud!ng culture# Soc!able, adaptable, "le9!ble# 3 really apprec!ate someone else, because 3 a@e pr!nc!ples E!" we wanrespect otersE# 3 am @ery e9c!ted to !ntroduce 3ndones!a to anyone !n te world and t!s e@ent !s my opportun!t!es "or do !t# F!ne@ent !s a opportun!t!es "or yout !n 'S(') espec!ally 3ndones!an yout generat!on "or de@eloped ab!l!ty !n commun!cat!on s
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.%. ((
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are eren n arespected ten
ally, 3 t!n tat t!sll !n engl!s or
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