Application for Hope and Dreams (HANDs) Projects

For University Students

Directions: Please type or print clearly, and fill in all blanks.

Deadline: Completed application form and other supporting documents must be
submitted to HANDs! Indonesia Secretariat, by 13:00 (WIB), Monday, July 13, 2015 by
e-mail
First Name Middle Name Family Name
Name
Noni Frista Al Azhari
Age (as
Attach your Date of dd/mm/yyyy of July ( )M
25 Sex
photo here Birth 1/8/1990 13, ()F
2015)
Country
Indonesia Citizenship Indonesia
of Birth

Current
Contact Sunan
Home
Kalijaga Street 1/ 9B, RT 06/ RW 01, Berkoh,South Purwokerto 53146
Information Address
Mobile 9E+10 Telephone E-mailnonifristaalazhari@gmail.com
University or Graduate
Major
School
Faculty Medicine
Jenderal Soedirman University
Information Batch
about
Affiliation Address Telephone (0281) 622022

Fax (0281) 624990

Dokter Gumbreg Street Number 1, Berkoh, Purwokerto 53146
E-mail fk@unsoed.ac.id

Please indicate which address you would like to use for correspondence:
Prefered Address
( ) at home ( ) at university
English Proficiency Certification (if
Language English Level
any)
Proficiency Type TOEFL Score 480 ( ) Fluent ( ) Fair ( ) Poor

( ) From The Japan Foundation, Jakarta's Facebook

( ) From The Japan Foundation, Jakarta's Twitter

How did you
learn about ( ) From The Japan Foundation, Jakarta's Website
HANDs!
Project? ( ) From a Friend

( ) Others

Oversea
Travel / Study
Experience (if
any)
 Oversea
Travel / Study I was a young doctor at the Margono Soekarjo General
Experience (if Hospital since one year ago. I studied medicine seven years
any) ago since it was first accepted in medical school in 2008. I
love the field of health and related fields.
My childhood living in Yogyakarta. I really like the education
and leadership. I also like nature, humanitarian,
Briefly environmental, social, cultural, and others.
explain about At the time of preclinical education, I am happy to join the
yourself, organization. I am pleased to follow the activities of the
including organization's activities because I can meet so many people,
your build relationships, share ideas.
background, The organization I was much involved with education and
personality, humanity. I've become a coordinator of education at the
as well as regional level Indonesian Profession Medical Student
your Association Executive Board. And once also as deputy
volunteer / coordinator of the national level. The student activity units in
internship / BEM I became a member of the field of medical assistance
professional team (TBM). The TBM, I learn about the skills in the medical
experience. field, for example, how to handle a medical emergency
Please focus condition, learn how to sew leather, and etc. It is important
on what are to train our medical capabilities.
related to the In addition, I often follow social activities, for example to the
HANDs! orphanage, to neighborhood health center for toddlers or the
Project. (750 elderly free health checks, routine event on Sunday in the
words city's sports griya free blood pressure checks, blood sugar
maximum) and cholesterol checks. I also dairy becoming foster parents
for children in poor families.
I often follow social activities eg kindergartens and
elementary schools to educate children about subjects, learn
Briefly brushing teeth, chanting, etc. I have also several times been
explain about filling counseling on prevention of dengue fever, the use of
your contraceptives, etc. in the village.
experience in
community-
based
ver. I was faced
activities,
with many problems and seek solutions. Before camp started, we still have to pe
preferably
disaster-
related
activities
(500 words
maximum)

Give us your experience in creative thinking and taking action. We define "creative"
as "to think out the of the box" to provide solution. Tell us about your own
experience that you faced to a problematic situation and you performed your
creative thinking to solve the problem. The situation could be from your design
work, community-based activities, organizing events and others. Show us how
creative thinker and do-er you are. (750 words maximum)

I often became the coordinator for various activities both in high school and
college. I used to face problems, and whenever possible I will communicate and
discuss with all members to find a solution. Sometimes there is a conflict between
us, but usually there will be results i a decision on the advice of other members so
that problems can be solved. Smooth communication is always necessary, since
communication failure may disrupt the event due to different perceptions. So we
always keep communication and clarify if there is a change of plans or things we do
not understand. For large events, and involve a lot of time, we also need to
establish good communication with other divisions. Consultation activities to ask
for advice to our teachers also remains we did, because the entire permit and
charge of the activity remains our teacher. To the contents of the activities, we
 I often became the coordinator for various activities both in high school and
college. I used to face problems, and whenever possible I will communicate and
discuss with all members to find a solution. Sometimes there is a conflict between
us, but usually there will be results i a decision on the advice of other members so
that problems can be solved. Smooth communication is always necessary, since
communication failure may disrupt the event due to different perceptions. So we
always keep communication and clarify if there is a change of plans or things we do
not understand. For large events, and involve a lot of time, we also need to
establish good communication with other divisions. Consultation activities to ask
for advice to our teachers also remains we did, because the entire permit and
charge of the activity remains our teacher. To the contents of the activities, we
have to think creatively as possible in order to how the event can be in demand by
a lot of people, not boring, and took us on a new and memorable experience.
Moreover, it should also add insight and knowledge. We learned from the
experience of the activities that have been done, then we thought to look for new
ideas. We learn both from the mistakes and successes that have been done before.

In the HANDs! Project 2015, the participants are expected to create a disaster
education related program as a group, that will be implemented in 2016. Please
explain your ideas about disaster education related program that will benefit local
communities and that you would like to create. Please specify 1) your target
population, 2) knowledge to be used, and 3) how to transfer/convey/communicate
it. Please tell us how you will contribute in realizing the project. Be creative! (750
words maximum)

1. Education about the knowledge of what to do when facing disasters such as

flood, earthquake, volcanic eruption, etc. to the local people. Simultaneously with
disaster simulation.
Target: people around, elementary school, junior or high school
Source of knowledge: Do myself or call a competent resource persons.
Technical: Done in the village hall or city hall, school, or public place.

2. create a brochure or pamphlet about the early handling of the disaster.

Target: Everyone. general public.
Source of knowledge: books, journals on the internet, writing reliable sources.
Technical: Pamphlets distributed to visitors in public places or sites or on the road.

3. Fundraising and come directly to the area being affected.

Target: People affected by the disaster.
Source: Fund sponsors.
Technical: Looking for sponsors or donors. Buying basic necessities for distribution
to needy residents. Participate in community service and helping with power.

I hereby certify that all the information given above is nothing but the truth.

ri Senin, 13 Juli 2015

Signature* Date

(* If you are submitting this form by email, paste electric image of your signature in
case that it is not possible, just type your name.)
(* If you are submitting this form by email, paste electric image of your signature in
case that it is not possible, just type your name.)

Please attach to this application form the following documents

1. Curriculum Vitae in English. This must not exceed 2 pages in length.

2.Any additional materials about your disaster related
activities