POST CODE: STATE: CONTACTS DETAILS. TEL NO: FAX NO: EMAIL: YOUTH ORGANIZATION (registered under Registrar of Youth (ROY)
NATIONAL YOUTH AND SPORTS DEPARTMENT MINISTRY OF YOUTH AND SPORTS MALAYSIA PASSPORT PHOTO
YOUTH EXCHANGE PROGRAMME
Application Form
Please (/) your preferences NO PROGRAMME 1 SHIP FOR SOUTHEAST ASIA YOUTH PROGRAMME 2 MALAYSIA – ASEAN RELATED PROGRAMME 3 MALAYSIA – INDIA YOUTH EXCHANGE PROGRAMME 4 MALAYSIA – KOREA YOUTH EXCHANGE PROGRAMME 5 MALAYSIA – JAPAN YOUTH EXCHANGE PROGRAMME 6 MALAYSIA – COMMONWEALTH PROGRAMME 7 PROGRAMME BY INVITATION
DURATION 2 MONTHS 7 – 10 DAYS 10 DAYS 7 – 10 DAYS 7 – 10 DAYS 7 – 10 DAYS 7 – 10 DAYS
Please complete all details with CAPITAL LETTERS SECTION A: PERSONAL DETAILS FULL NAME GENDER MALE ( ) FEMALE ( ) I/C NUMBER MARITAL SINGLE ( ) MARRIED ( ) STATUS DATE OF (day) (month) BIRTH PLACE OF BIRTH HEIGHT / (cm) WEIGHT RELIGION / RACE ISSUING OFFICE: DATE OF ISSUE: PASSPORT NUMBER
(year)
(kg)
DATE OF EXPIRY:
HOME ADDRESS POST CODE: CONTACT DETAILS
STATE:
EMAIL:
MOBILE PHONE:
SECTION B: EMPLOYMENT INFORMATION (if you are currently working) NAME OF EMPLOYER OCCUPATION/ POSITION OFFICE ADDRESS POST CODE: CONTACTS DETAILS WORKING EXPERIENCES
TEL NO:
STATE: FAX NO:
(/)
SECONDARY SCHOOL/COLLEGE/UNIVERSITY (you currently attend/attended) NAME OF SECONDARY SCHOOL/COLLEGE/UNIVERSITY FIELD OF STUDY ADDRESS POST CODE: CONTACTS DETAILS
TEL NO: EMAIL:
STATE: FAX NO:
YOUTH ORGANIZATION (registered under Registrar of Youth (ROY) / affiliated with National Youth Council) NAME OF YOUTH POSITION ORGANISATION/CLUBS ADDRESS POST CODE: CONTACTS DETAILS
TEL NO: EMAIL:
STATE: FAX NO:
PRESIDENT/SECRETARY SIGNATURE & OFFICIAL STAMP
STATE DEPARTMENT OF YOUTH AND SPORTS VERIFICATION: The applicant is an employee of this department:
OFFICIA L
-----------------------------(Director) Signature: Date: SECTION C: ADDITIONAL INFORMATION DIETARY RESTRICTIONS (e.g. vegetarian, food allergies) HOBBIES/ SKILLS/ SPECIAL INTERESTS EMERGENCY NAME (RELATIONSHIP) : CONTACT (NEXT OF KIN) INTERNATIONAL PROGRAMME EXPERIENCES (past 3 years)
STAMPS
MOBILE NO / OFFICE NO:
LANGUAGE (S)
PROFICIENCY (indicate poor, fair, good or fluent) SPEAKING READING WRITING
GUIDELINES FOR YOUTH EXCHANGE PROGRAM FORM APPLICATION
1.
Read all directions on each page carefully before completing the application. Ensure that you have completed all sections and obtained all necessary signatures.
2.
Enter your name exactly as it appears in your Malaysia identification card or passport.
3.
The International Affairs Unit, Youth Development Division will ONLY ACCEPT ORIGINAL and COMPLETED FORMS (WITH ESSAY and OFFICIAL STAMP). Forms that are received via fax / email / photocopied will NOT BE CONSIDERED.
4.
Please attach (2) latest passport size photos with your COMPLETED FORM. The photos should be set on a white background, showing head and shoulders only. Attached photographs must be originals or good quality colour copies.
5.
MALAYSIAN only.
6.
Age between 18 to 30 years’ old.
7.
Not backlisted by PTPTN or Immigration Department. Not a bankrupt or facing any disciplinary or criminal charges.
8.
Able to communicate effectively in English. Ability to do the same in other languages is an advantage.
9.
Able to participate in camp selection and predeparture training as designated by the Ministry.
10. Definite team player.
11. Application forms and essay MUST be submitted via respective youth organizations. For a nonmember, application form and essay can be submitted via respective state Youth and Sports Department. 12. Hand written or typed applications are preferred. Answer all questions completely and as asked (please refrain from writing “same”, “see above”. Make sure to use correct spelling and grammar. 13. If you have any questions on completing this application, kindly check with your youth organization representative or Youth and Sports officer at respective state departments/offices. 14. Last, but not least, submit an English essay on a topic of your choice within 300 words. Let your imagination soar! 15. COMPLETED FORMS AND ESSAYS must be send to and reach the address below before or on the 15 JANUARI 2017. Forms received later than the due date WILL NOT BE CONSIDERED:
INTERNATIONAL AFFAIRS UNIT, Youth Development Division, National Youth And Sports Department, Ministry Of Youth And Sports Malaysia, Level 11, Kbs Tower, Precinct 4, No 27, Persiaran Perdana, 62570 Putrajaya. Tel : 03-88713744/3796/3371 Fax: 03-88888761 (Attn: Cik Nageswary A/P Thiagarajan/Puan Naziah Dollah/Encik Hafizan Ahmad) ACKNOWLEDGMENTS
I hereby certify that the above information given are true and correct as to the best of my knowledge. Submission of any false information will render my application void Full name: Signature: Date:
