NYCIntlProgramsAppForm - LastName, FirstName

NATIONAL YOUTH COMMISSION INTERNATIONAL PROGRAM
APPLICATION FORM
Not for Sale May be reproduced
INTERNATIONAL PROGRAM APPLYING FOR:
1. Surname:
_______________________________ 2. Gender: [ M ] [ F ]
First Name: _______________________________ 3. Height: ________
Passport-sized photo
Middle Name: ______________ 4. Weight: ______5. Age:_______________

Nickname: ___________ 6. Birthdate: __________________7. Birthplace: __________________
8. Current Address: ____________________________________________________ 9. Region:____
10. Years of Stay: ________________ 11. Tel. No. (Landline/Area Code):_______________________
12. Zip Code: _____ 13. Email Address: _________________14. Cellphone No: ________________
_______________________
Pls. Indicate date taken
15. Religion: __________________16. Present Occupation/Position: _________________________

17. Name of Office: ________________ 18. Office Address: ________________________________
Date Taken:
19. Years in the Present Work: __________________ 20. Civil Status: _______________________
Passport Details
21. Number
Place of Issue:
22. Type
Official
General
23. Date of Issue

24. Date of Expiry
25. Name (Relationship):
Emergency Contact
27. Phone:
28. Mobile Phone:
26. Address:
29. Fathers Name: Marc Red A. Marinas

Place of Birth: Manila
30. Mothers Name: Rhea A. Magpayo
Place of Birth: Manila
31. No. of Brother/s: 1
32. No. of Sisterr/s: 1
33. Educational Background
Name of School/University
Course / Inclusive Dates
Elementary
South Crest School
2002 - 2008
Secondary
South Crest School
2008 - 2012
Tertiary
University of Perpetual Help
2013 - Present
System DALTA
Vocational
Post Graduate
34. Scholarship Grants
Donor
Inclusive Dates
35. Youth Organization/Youth Serving Organization Affiliations:

Name of Organization
Position
Rotary Interact Club
Member
NFJPIA NCR
Member
JPIA UPHSD
VP for Non-Academic Affairs
Occupation: Immigration Officer

Occupation: Housewife
Honors Received
Salutatorian
Years of Membership
2011-2012
2013-Present
2015-Present
Honors Received
Accomplishments
36. Special Skills or Talents:

37. Food Restrictions:
None
39. Dialect(s) or Foreign Language(s) Spoken:
Filipino and English
40. Title of Seminar/Training Course Attended
41. Previous Work Experience
38. Allergies
None
Inclusive Dates
No. of Hours
Conducted by
Name of Company
University Savings and Loans Bank
42. Character References:

Name
Position
Intern
Inclusive Dates
2015-2016
Salary
None
[not related to you within the third degree of consanguinity]

Occupation
Address and Telephone No.
All facts and data given in this information sheet will be treated with utmost confidentiality
44. Have you previously applied for any NYC International Exchange Program? No
Yes
How many times? ________________
If yes, please indicate the program/s and year/s: ________________________________________________________________________

No
45. Have you been a participant of any NYC International Exchange Program?
Yes
How many times? _______________
If yes, please indicate the program and year: _______________________________________________________________________

46. How did you know about the program?
Facebook: _____
Twitter: ______
Website:
E-mail from NYC: ______
_____
Others [pls. Indicate]: _____________________________________________________

47. Have you availed of any program or scholarship grant offered by any foreign government? [ ] No
[ ] Yes
If yes, please indicate the program, year, and name of organizer

48. Have you attended any seminar, conference or trainings abroad? [ ] No
[ ] Yes
If yes, please indicate the program and year _______________________________________

49. Have you been involved with any NYC local program or activity? [ ] No
[ ] Yes
If yes, please indicate the program(s) and year ______________________________________

50. Have you ever been convicted of any crime involving moral turpitude? [ ] No
[ ] Yes
If yes, please indicate the nature and status

51. Do you have any pending case? [ ] No [ ] Yes
If yes, please indicate the nature and status
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
any information given by me that is untrue may constitute a disqualification to any NYC programs.
The undersigned expressly authorizes the National Youth Commission or its representatives to use, share, and process my personal information I
have provided, shared, or declared in this form for any lawful purpose.
Further, I subscribe and agree that the National Youth Commission has the sole prerogative to select and nominate the delegates to any
International Program, and its decision is final and executory.
IN WITNESS hereof, I am executing and signing this statement voluntarily without compulsion.
_____________________________
Signature
______________________________
Printed Name
NOTE:
The National Youth Commission reserves the right and prerogative to exclude applicants who will not meet the minimum requirements of the
Program. Lack or non-compliance of any of the above stated requirements will mean automatic disqualification without notice.
Mail or hand carry your application to the International Committee, National Youth Commission, 4 th Flr., Bookman Building, 373 Quezon
Avenue, Quezon City, Tel No. 4162833.
Please fill out the form legibly

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NATIONAL YOUTH COMMISSION INTERNATIONAL PROGRAM

First Name: _______________________________ 3. Height: ________

Middle Name: ______________ 4. Weight: ______5. Age:_______________

15. Religion: __________________16. Present Occupation/Position: _________________________

23. Date of Issue

29. Fathers Name: Marc Red A. Marinas

35. Youth Organization/Youth Serving Organization Affiliations:

Occupation: Immigration Officer

36. Special Skills or Talents:

41. Previous Work Experience

42. Character References:

[not related to you within the third degree of consanguinity]

Address and Telephone No.

How many times? ________________

If yes, please indicate the program/s and year/s: ________________________________________________________________________

How many times? _______________

If yes, please indicate the program and year: _______________________________________________________________________

E-mail from NYC: ______

Others [pls. Indicate]: _____________________________________________________

If yes, please indicate the program, year, and name of organizer

If yes, please indicate the program and year _______________________________________

If yes, please indicate the program(s) and year ______________________________________

If yes, please indicate the nature and status

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First Name: _______________________ 3. Height:

Middle Name: 4. Weight: 5. Age:___

15. Religion: 16. Present Occupation/Position: _______