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Exchanger Program Form

This document appears to be an application form for an exchange program called Youth For Understanding (YFU). It requests information such as the applicant's name, date of birth, gender, religion, address, parent/guardian contact details, passport information, English and other language proficiencies, hobbies and interests, and agreement to the selection process requirements. The applicant is asked to sign agreeing to participate in selections and follow the program rules.

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25 views2 pages

Exchanger Program Form

This document appears to be an application form for an exchange program called Youth For Understanding (YFU). It requests information such as the applicant's name, date of birth, gender, religion, address, parent/guardian contact details, passport information, English and other language proficiencies, hobbies and interests, and agreement to the selection process requirements. The applicant is asked to sign agreeing to participate in selections and follow the program rules.

Uploaded by

nosef824
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
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Y+U!" F+R UN$ERS!

AN$&NG &N$+NES&A

Data Peserta Exchange Program 20 1. Nama Lengkap


(Sesuai Passport dan foto copy-nya)

: : : : : : : : : : : : : : : : : :

20

2. 3. . #. (. *.

Nama Panggilan Tempat/Tgl Lahir !enis "elamin $sia pa%a &'lan )gama )lamat

Telephone/+ax ,an%phone E-mail -. Nama .rang T'a )/ah 1&' 2. )lamat 3&ila tak sama4 Telephone/+ax ,an%phone )/ah ,an%phone 1&' E-mail )/ah E-mail 1&' 10. 5+$ Program ). ,igh 6chool Prgram 3,6P4 Negara T'0'an Program Pilihan Negara T'0'an

Peker0aan: Peker0aan:

: : USA, GERMANY, FRAN E, !"E NE!"ER#AN$S, %E#G&UM, "&NA, AUS!RA#&A, 'APAN, S(&)ER#AN$, ME*S&*+ $AN !UR*& : ,./-

7.

2 3T8o4 5ear 9omm'nit/ 9ollege Program 399P4

: "elas: : : :

Dimana sekolah an%a saat ini : 11. Nama )lamat Telephone/+ax

)pakah an%a s'%ah memp'n/ai passport: 12 5a ;asa &erlak' : . Ti%ak ;ohon segera mem&'atn/a )pakah an%a s'%ah/pernah memiliki <isa Negara T'0'an: 13 5a . Ti%ak Tingkat kemamp'an &er&ahasa 1nggris an%a: 1 Tert'lis Elementr/ . 1nterme%iate 1# 9on=ersation Elementr/ . 1nterme%iate Tingkat kemamp'an 1( 7ahasa-&ahasa lainn/a: a. &. c. 1*. 7'%a/a : 3;enari> %ll4 1-. "esenian : 3;en/an/i4 12. 7ela %iri : 3Pencak silat> %ll4 Dengan ini sa/a men%a?tarkan %iri 'nt'k mengik'ti Pro0ra1 Pertu2aran Pe3a4ar Yout5 For Understandin0 PY6 P 20.... @ 20A > %engan ketent'an se&agai &erik't : a. 6angg'p mengik'ti seleksi-seleksi %an memat'hi ketent'an/perat'ran pa%a pert'karan pela0ar ini. &. ;em&a/ar registration ?ee !akarta> ..................20AA .rang T'a 9alon Peserta> 9alon Peserta> )%=ance )%=ance

Lama mempela0arin/a

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