A sian Y outh F orum 13

January 27 February 2, 2015

Bangkok, Thailand
www.asianyouthforum.org

AY F 1 3 A P P L I C AT I O N F O R M
(for on-line applicants)

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 13th 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 sian Y outh F orum 13

PERSONAL DATA
Complete Name
(as in passport)
Last name (family name)
First name
Nickname
Age
Sex
Marital Status
Date of Birth
Nationality

Annisa Rahmani

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:
:
:
:

Rahmani
Annisa
Nisa
21
Female
Single
August 21, 1993
Indonesia
Jl. Dr. Sutomo Gg. Gili Anyar 1 No. 15, Karang Baru
Mataram, Indonesia
0370-625677
+6285792044952
semangatanis@gmail.com

:
:

Complete Home Address

Landline Phone Number

Mobile Phone Number (cell)
E-mail address #1
E-mail address #2

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:
:
:

PASSPORT DATA
Passport No.
Date of Issue
Date of Expiry
Place of Issue

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:
:
:

EDUCATION / FUTURE PLANS

Name of school / university
Your Faculty / Department
Degree/Major and Year Level

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:
:

Your Career Plans

Islamic University of Al-Azhar Mataram

Medical Faculty
Medical Education and 3rd year

SPONSOR (A teacher or mentor who can recommend you)

Name and Title
University or Organization
E-mail Address

:
:
:

Dr. IIng
Lecture on Islamic University of Al-Azhar Mataram

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
E-mail address
Relationship to applicant

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:
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:

087865633171
Yuni.husni@ymail.com
Sister

OTHER INFORMATION
Foreign languages

English

Special skills

Trainer, Conceptor,

Overseas experience

Allergy, food, health problems

pork meat

Song (not good like a singer but I can do that)

Medicine, education and environment

A cultural performance you

could do (song, dance.)
Three (3) social issues that

The 13th 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 sian Y outh F orum 13

youre most concerned with

SHORT 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 didnt 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)

The 13th 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 sian Y outh F orum 13

[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
words)

The 13th 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.