DEPARTEMENT
OF YOUTH AND SPORT OF WEST NUSA TENGGARA
PURNA
CARAKA MUDA INDONESIA (PCMI) NTB
INTERNATIONAL YOUTH EXCHANGE PROGRAM
International
Youth Exchange Program is official program under the ministry of youth and
sport of Indonesia that is open for Indonesian youths who believe that they are
the agent of change. This program is aimed to share mutual understanding of diversities
among countries in the world and to broaden their knowledge of different
culture.
This
program offers various meaningful experiences e.g. cultural performance,
staying with host family, community development, official dialogue with youth
from many different nations and work experience.
Term
and Condition
·
Holding
Indonesian Citizenship
·
Mentally and
physically healthy
·
You have to be
18-30 years old
·
Inquisitive,
open minded, leadership, responsible, confident and having well knowledge about
local and national culture.
·
Speak fluent
communicative English
·
English
proficiency with minimum TOEFL (ITP/Prediction) score 450
·
A copy of Grade
Point Average (GPA) from last semester for university student/a copy of High
School Certificate for fresh graduate student/A copy of GPA and certificate
bachelor degree for fresh graduate
·
Completing
application form
Send the entire document via post to Jln
Swakarya III. No.38 Kekalik (Belakang Pemancar SCTV) Mataram due date 20 April 2013.
Contact person: Agus Salim
Email
address: pcmi_ntb@yahoo.com
Hp: 081917084004
Ziadah Ziad
Hp: 087865934144
DEPARTEMENT
OF YOUTH AND SPORT OF WEST NUSA TENGGARA
PURNA CARAKA
MUDA INDONESIA (PCMI)
Jln
Swakarya III. No.38 Kekalik (Belakang Pemancar SCTV) Mataram
INTERNATIONAL
YOUTH EXCHANGE PROGRAM 2013
Application
Form
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1.
Applicant Detail
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a.
Name
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b.
Date of birth
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d.
Current Home
Address
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e.
Telp/Mobile
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f.
Email Address
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2. Special
Circumstances
Do you suffer from any particular
disease, allergy or have any past serious ill?
If “Yes” Please give details
3. Academic Qualification
Please
provide the following information for all completed senior high school,
vocational, technical, and undergraduate or the last training and the last GPA
if you currently study.
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No
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Educational Institution
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Faculty/Program
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Field of Study
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GPA
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Please
specify any scholarship and youth event that you have experienced
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4.
Language Proficiency
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None
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Basic
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Conversational
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Fluent
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Indonesian
English
Local
Tongue
Please specifies another language
that you can speak
Have
you undertaken an IELTS, TOEFL, IBT or CEF test? If you have undertaken one of
the tests or more, please note the result in the box below (TOEFL Prediction is
accepted).
5. Employment/Organization/Community
Involvement Record
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Name of
Employer/Organization
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Title of position held
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Year
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(From-To)
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6. Skill and
Talent
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No
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Skill and Talent
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None
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Basic
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Moderate
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Good
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7.
Supporting Statement
Write a clear
and detailed explanation of your reason why you would like to participate in
International Youth Exchange Program. Elaborate how this program fits with your
future objectives (This statement is an important part of your
application—please use additional paper if it is necessary).
Write one of the most pressing issues
especially faced by West Nusa Tenggara or Indonesia at general and what role
that you want to play in order to reduce or to solve that issue.
8. Applicant’s
Declaration
I certify that the statements made by me
in this application for an International Exchange Program are true, complete
and correct to the best of my concern.
_________________________________ ____________________________
Printed
Name and Signature of Applicant Date
