Youth Exchange Programme: ASEAN-Korea Youth Square Seoul & Gangwon-do, Korea / 5 to 10 February 2015

Please complete this form based on your passport. (The title of e-mail should be 'ASEAN-Korea_name of participant')

Personal Information

First Name: Halimah

PHOTO HERE

Last Name: Tussakdiah

Full Name (with Middle Initial): Nyayu Halimah Tussakdiah

Gender (Female/Male): Female

Nationality as shown on passport: Indonesian

Year of Birth (YYYY-MM-DD): 1995-06-24

Passport Number:

- Date of Expiry:

Religion: Moslem

Contact Information

Current Address: Jl. Kiranggo Wirosentiko Num. 282 RT 12/RW 004, 30 ILIR 30144 City: Palembang

Country of residence: Indonesia

Contact e-mail:

Telephone with country code (e.g. 82-2-000-000): 62-711-363670

Mobile with country code: 6287-7700-177

Additional Information

Name of your latest school (or work) : STATE POLYTECHNIC OF SRIWIJAYA

English proficiency (Advanced/Native): Advanced

Preferred t-shirt size XS / S / M / L / XL / XXL / XXXL

Special Requests & Medical Conditions

Prohibited food(s): Pork, dogs, and alcohol

Allergies to (food, medicine, plant, and etc): none

If you are on special medication, let us know: none

Why should you be selected ?

The 16th ASEAN-Korea Future-Oriented

Dianeffendy06@gmail.com

Because I have passion in cooking, especially Palembang cuisine and I love dancing too. Not only traditional dance but also modern dance included K-pop dance. I always train myself by watching all of video which have related to dance and music whereas Palembang cuisine, I like to help my mother to prepare the foods and beverages which all of them is traditional cuisine such as Pindang, Pempek, Brenkes and others. In academic, I'm student in Chemical English Departement and my IPK is 3,72. I'm good in english and can speak it well. I get A in English lesson and join English Debate Society and Technology and Science Society in my campus. In addition, I have

Youth Exchange Programme: ASEAN-Korea Youth Square Seoul & Gangwon-do, Korea / 5 to 10 February 2015

Please complete this form based on your passport. (The title of e-mail should be 'ASEAN-Korea_name of participant')

Personal Information

PHOTO HERE

Contact Information

Jl. Kiranggo Wirosentiko Num. 282 RT 12/RW 004, 30 ILIR 30144

Palembang

Indonesia

62-711-363670

6287-7700-177

Additional Information

STATE POLYTECHNIC OF SRIWIJAYA

Advanced

XS / S / M / L / XL / XXL / XXXL

Special Requests & Medical Conditions

Pork, dogs, and alcohol

none

none

Why should you be selected ?

Because I have passion in cooking, especially Palembang cuisine and I love dancing too. Not only traditional dance but also modern dance included K-pop dance. I always train myself by watching all of video which have related to dance and music whereas Palembang cuisine, I like to help my mother to prepare the foods and beverages which all of them is traditional cuisine such as Pindang, Pempek, Brenkes and others. In academic, I'm student in Chemical English Departement and my IPK is 3,72. I'm good in english and can speak it well. I get A in English lesson and join English Debate Society and Technology and Science Society in my campus. In addition, I have