7/29/2019 Application Form for Participating Youth-2013 With
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THE 40th SHIP FOR SOUTHEAST ASIAN YOUTH PROGRAM (SSEAYP)
2013 APPLICATION FORM FOR PARTICIPATING YOUTH (PY)
REGION TO BE REPRESENTED:____________________
Surname: ____________________________________ Gender: [ M ] [ F
]
First Name: ____________________________________ Height:
______________
Middle Name: __________________ Weight: _________
Age:__________________
Nickname: ___________ Birthdate: _______________ Birthplace:
______________
Official Mailing Address:
__________________________________________________
____________________________________________Zip Code:
_______________
Residence Address:
_____________________________________________________
Tel. No. (landline/Area Code): _____________ Mobile
No.:_____________________
Email Address: _______________________
Religion: ________________ Present Occupation/Position:
____________________
Name of Office or school: ____________ Office or School
Address:_______________
Years in the Present Work: ______________ Civil Status:
_____________________
Passport-sized photo
_______________________Pls. Indicate date taken
Fathers Name: Place of Birth: Occupation:
Mothers Name: Place of Birth: Occupation:
No. of Brother/s
No. of Sisterr/s
Educational Background Name of School/University Course /
Inclusive Dates Honors Received
Elementary
SecondaryTertiary
Vocational
Post Graduate
Scholarship Grants Donor Inclusive Dates Honors Received
Youth Organization/Youth Serving Organization Affiliations:
Name of Organization Position Years of Membership
Accomplishments
Special Skills or Talents:
Food Restrictions: Allergies
Dialect(s) or Foreign Language(s) Spoken:
Do you have a passport already? Yes ____ No ____If yes, what is
the number __________________ Expiry Date _______________If not,
have you applied already? Yes ____ No ____If yes what is the status
of your application? _____________________________
Title of Seminar/Training Course Attended Inclusive Dates No. of
Hours Conducted by
Previous Work Experience
Name of Company Position Inclusive Dates Salary
Character References: [not related to you within the third
degree of consanguinity]
Name Occupation Address and Telephone No.
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7/29/2019 Application Form for Participating Youth-2013 With
Logos
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All facts and data given in this information sheet will be
treated with utmost confidentiality
Please name any SSEAYP Alumni you know Relationship
Have you previously applied for SSEAYP? No Yes How many
times?
How did you know about the program?Newspaper: _____ Radio:
______
Magazine: _____ TV Ads: ______
NYC Personnel: ________________________________
(Name of NYC personnel)Others [pls. Indicate]:
____________________________
Have you been a participant of any NYC International
ExchangeProgram? [ ] No [ ] Yes
If yes, please indicate the Program, year and source of fund
Have you rendered voluntary service for the NYC? ? [ ] No [ ]
Yes If yes, please state nature of service and how long
Have you been involved with any NYC local program or activity? [
] No [ ] Yes If yes, please indicate the program(s) and year.
If no, are you willing to enter into a MOA with NYC to render
voluntary work for its programs and activities?
Have you joined or attended any SSEAYP activities? [ ] No [ ]
Yes If yes, please indicate
Have you availed of any program or scholarship grant offered by
the Japanese government? [ ] No [ ] Yes If yes, please indicate the
program and year
Have you attended any seminar, conference or trainings abroad? [
] No [ ] Yes If yes, please indicate the program and year
Do you anticipate to take part in any program, conference,
board/bar exams or scholarships this year? [ ] No [ ] Yes If yes,
please indicate details
Are you on a scholarship granted by the Department of Science
and Technology (DOST) and/or any other government agencies? [ ] No
[ ] YesIf yes, please indicate
Have you ever been convicted of any crime involving moral
turpitude? [ ] No [ ] Yes If yes, please indicate the nature and
status
Do you have any pending civil and administrative case? [ ] No [
] Yes f yes, please indicate the nature and status (you will be
required to present clearance).
Do you have any physical disability? [ ] Yes, please specify
_____________________________ [ ] No
SWORN STATEMENT
I hereby certify upon my honor that all facts and information
indicated herein are true and correct to the best of my knowledge.
I further declare that anyinformation given by me that is untrue
may constitute a ground for expulsion in the SSEAYP and prosecution
for perjury.
Further, I subscribe and agree that the National Youth
Commission has the sole prerogative to select, reclassify and
nominate the delegates to the Ship forSoutheast Asian Youth Program
[SSEAYP], and its decision is final and executory. And if chosen, I
will join the activities of the program such as Pre-departure
training (July 16-25), pre-departure activities (Sept. 28-Oct. 27),
cruise (Oct.28-Dec.16) and post-program evaluation (Dec.17-19).
The undersigned expressly authorizes the National Youth
Commission or its representatives to use, share and process
personal information that I have
provided, shared or declared in this form/document/site for any
lawful purpose.
IN WITNESS hereof, I am executing and signing this statement
voluntarily without compulsion._____________________________
Signature
Res. Cert. Number: ____________________ Date
accomplished:______________Date and Place Issued:
_________________
Qualifications:
1. Filipino citizen, single, must be between 18-30 years old as
of April 1,2013.
2. Before the date set for the submission of application, must
not have beencharged before the prosecutions office or convicted of
a crime involving moralturpitude
3. physically and mentally fit to travel
4. must be residing at the place of representation for at least
six (6) monthsat the time of application
a. if not employed or nor studying, must be residing in the
region to berepresented for at least two (2) years immediately
preceding the dateof application;
b. If employed, the applicant must be working in the region to
berepresented for at least six (6) months immediately preceding the
dateof application;
5. If a student, the applicant must be studying in the region to
berepresented for at least six (6) months immediately preceding the
date ofapplication; if at the time of application, the applicant
has less than six (6)months of stay in the workplace, school or
residence, the Paper ScreeningCommittee reserves the right to
determine the applicants regionalrepresentation
6. If a student wishes to apply to represent a particular
region, he/she mustpresent a certification duly signed by the head
of the organization that theapplicant is actively participating in
the regions youth-related activities for atleast six (6) months
immediately preceding the date of application;
7. Must have served the youth sector as an active officer or
member of ayouth or youth serving organization for at least two (2)
years immediatelypreceding the date of application
8. must have a strong background in Philippine history,
geography, cultureand arts
9. must be knowledgeable on current issues about the
Philippines, Japanand the other ASEAN countries
10. preferably first time international traveler and or must not
have been a
a. grantee or recipient of any NYC-coordinated international
program,wherein round-trip airfare, food and accommodation were
borneby the organizer/s, at least two (2) years immediately
precedingthe date of application;
b. grantee or recipient of any NYC-coordinated international
program,wherein round-trip airfare was shouldered by the
participants, atleast one (1) year immediately preceding the date
of application
11. Must be willing to be an NYC volunteer after the program;
and12. Must be will ing to take a leave of absence from school or
work and
complete all trainings and activities before, during and after
the program:
Pre-departure Training July 16-25, 2013Pre-departure Activities
Sept. 28 - Oct. 27, 2013Cruise Oct. 28 - Dec. 16, 2013Post-Program
Evaluation Dec. 17-19, 2013
13. Must be willing to craft a policy paper to be submitted
within one hundred(100) days from end of the program.
Requirements: [ Please submit only the required documents]
1. One (1) copy of application form with passport sized photo.
Photoshould have a white background, original and not scanned.
2. One (1) copy of the applicants resume (maximum of 3 pages
only;no other attachments)
3. One (1) original copy of the Certificate of Residency issued
by thePunong Barangay where the applicant is residing
4. One (1) original copy of a certification from the
organization that theapplicant is an active member for at least two
(2) years immediately
preceding the application period.
NOTE:
Non-extendible deadline for submission of application form is
5:00oclock pm on April 12, 2013.
The National Youth Commission reserves the right and
prerogativeto exclude applicants who will not meet the minimum
requirements of theProgram. Lack or non-compliance of any of the
above statedrequirements will mean automatic disqualification
without notice.
Mail or hand carry your application to Ms. Marielou A. Chua,
National YouthCommission, 4th Flr., Bookman Building, 373 Quezon
Avenue, Quezon City.Telephone No. 02-4162833. Application form with
the requirements may besubmitted [email protected] or
before April 12, 2013.
Passport must be valid until April 25, 2013
NYC AREA OFFICES
LUZON VISAYAS MINDANAO
Room 15, Hotel LegardaNo. 12, Legarda Road,
Ground FloorNaga City Youth
5/F B. F. BuildingN. Escario St.,
2/F Marell BuildingTiano-Gomez St.
3/F Atilano Bldg.,Veterans Ave.,
Davao Area Office, OldBldg. ARDS Room,
mailto:[email protected]:[email protected]:[email protected]:[email protected]
