A Asian sian YYouth outh FForum orum 1313January 27 – February 2, 2015

Bangkok, Thailandwww.asianyouthforum.org

AYF 13 APPLICATION FORM ( for on- l ine appl i cants)

What to submit:1. A completed AYF application form (below)2. A digital passport-sized ID photo (business/formal attire against a light background)

How to submit: (1) Fill out this form, save it as a .doc or .pdf file and name it as:

AYF13_APP_YOURCOUNTRY_YOURLASTNAME (e.g. AYF13_APP_KOREA_KIM.pdf)

(2) Send this form via e-mail with the subject line: AYF13_APP_YOURCOUNTRY_YOURLASTNAME

(3) Send your e-mail and attachment to:

asianyouthforumthailand@gmail.com

Deadline: Submit your application form and digital photo by October 10, 2014

AYF Eligibility Participation in AYF 13 is open to all Asian college/university students and youth (aged 18 – 25) Applicants must have good English proficiency and an interest in Asian peoples, cultures and issues Applicants must be an Asian country national/citizen from the Asian region

AYF Sponsor All applicants should include the name, title and e-mail of a sponsor who can recommend them. This sponsor should be a teacher, professor, mentor or the leader or staff of your organization.

Notification of Acceptance An official announcement about your acceptance will be made by the end of October. All successful candidates will be asked to confirm their attendance at AYF 13 in Bangkok. A complete list of AYF 13 participants will be posted to the AYF website in November.

The 13The 13thth Asian Youth Forum (AYF 13) Asian Youth Forum (AYF 13) will be held as part of the PAC@Thai TESOL Pan Asian Conference on English Language Teaching held from January 29 – 31, 2015 in

Bangkok, Thailand.

A Asian sian YYouth outh FForum orum 1313PERSONAL DATA

Complete Name(as in passport) : Annisa RahmaniLast name (family name) : RahmaniFirst name : AnnisaNickname : NisaAge : 21Sex : FemaleMarital Status SingleDate of Birth : August 21, 1993Nationality : IndonesiaComplete Home Address : Jl. Dr. Sutomo Gg. Gili Anyar 1 No. 15, Karang Baru

Mataram, IndonesiaLandline Phone Number : 0370-625677Mobile Phone Number (cell) : +6285792044952E-mail address #1 : semangatanis@gmail.comE-mail address #2 :

PASSPORT DATAPassport No. :Date of Issue :Date of Expiry :Place of Issue :

EDUCATION / FUTURE PLANSName of school / university : Islamic University of Al-Azhar MataramYour Faculty / Department : Medical FacultyDegree/Major and Year Level : Medical Education and 3rd year

Your Career Plans :

SPONSOR (A teacher or mentor who can recommend you)Name and Title : Dr. IIngUniversity or Organization : Lecture on Islamic University of Al-Azhar MataramE-mail Address :

CONTACT PERSON (in case of emergency)Name : Amaliya Rahmatin

Complete Address : Jl. Dr. Sutomo Gg. Gili Anyar 1 No. 15, Karang Baru Mataram, Indonesia

Landline Phone Number :Mobile Phone Number : 087865633171E-mail address : Yuni.husni@ymail.comRelationship to applicant : Sister

OTHER INFORMATION Foreign languages : EnglishSpecial skills : Trainer, Conceptor,

Overseas experience : -Allergy, food, health problems : pork meatA cultural performance you could do (song, dance….) : Song (not good like a singer but I can do that)

Three (3) social issues that you’re most concerned with :

Medicine, education and environment

The 13The 13thth Asian Youth Forum (AYF 13) Asian Youth Forum (AYF 13) will be held as part of the PAC@Thai TESOL Pan Asian Conference on English Language Teaching held from January 29 – 31, 2015 in

Bangkok, Thailand.

A Asian sian YYouth outh FForum orum 1313SHORT ESSAYS

[1] Please introduce yourself. Explain your background. What skills and experience can you bring to AYF? (200 words)

Hi, my name is Annisa.. I am the oldest in my family. My father is politician and my mother is businesswoman but I choose to be a medical student because I have a dream to be a good doctor in my country, as we know the developing countries have a lot of health problem because of that I hope I can be the one of them who help the others with my skills sincerely.

Otherwise, I am an organizational.. it is my hobby to join organization since my junior high school. There are Indonesian Moslem Student Association, Journalism Club, Executive body of student, Indonesian Medical Executive Board Associatin, Indonesian Youth Forum (FIM), etc. all of them help me to develope my self with their Leadership & life skill training, especially with the experience in structure organization.

[2] What motivated you to apply to AYF 13? Why do you think you should be an AYF participant? (200 words)

Honestly, I really feel grateful I didn’t lose the deadline of AYF in this time, so I can apply.

I Think I have to Increase my self with the International or Regional (Asia or asean) forum because during this time I just meet with Indonesian young people, sometime foreigner student in some leadership training.

I think AYF will give the more excited experience like meet with Asian Youth and sharing experience and make a friendhip in Asian zone, meet with the Great Facilitator, Indeed the extensive klowledge that I can get.. all of experience that I can Implement to develop my home country.

[3] The Asian Youth Forum promotes international understanding, social responsibility, friendship between Asian peoples and positive social action. How will you implement these AYF ideals in your home country after AYF 13? (200 words)

[4] What do you think are the most important social and global issues in Asia? What initiatives and activities should Asian Youth do to help solve these? (200 The 13The 13thth Asian Youth Forum (AYF 13) Asian Youth Forum (AYF 13) will be held as part of the PAC@Thai TESOL Pan

Asian Conference on English Language Teaching held from January 29 – 31, 2015 in Bangkok, Thailand.

A Asian sian YYouth outh FForum orum 1313words)

The 13The 13thth Asian Youth Forum (AYF 13) Asian Youth Forum (AYF 13) will be held as part of the PAC@Thai TESOL Pan Asian Conference on English Language Teaching held from January 29 – 31, 2015 in

Bangkok, Thailand.