NATIONAL YOUTH COMMISSION INTERNATIONAL PROGRAMAPPLICATION FORM

Not for Sale – May be reproduced

INTERNATIONAL PROGRAM APPLYING FOR:

1. Surname: _______________________________ 2. Gender: [ M ] [ F ]

First Name: _______________________________ 3. Height: ________

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: ________________

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

17. Name of Office: ________________ 18. Office Address: ________________________________

19. Years in the Present Work: __________________ 20. Civil Status: _______________________

Passport-sized photo

_______________________Pls. Indicate date taken

Date Taken:

Passport Details

21. Number Place of Issue:

22. Type Official General

23. Date of Issue

24. Date of Expiry

Emergency Contact

25. Name (Relationship): 27. Phone:28. Mobile Phone:

26. Address:

29. Father’s Name: Place of Birth: Occupation:30. Mother’s Name: Place of Birth: Occupation:31. No. of Brother/s:32. No. of Sisterr/s:33. Educational Background Name of School/University Course / Inclusive Dates Honors Received

ElementarySecondaryTertiaryVocationalPost Graduate

34. Scholarship Grants Donor Inclusive Dates Honors Received

35. Youth Organization/Youth Serving Organization Affiliations:Name of Organization Position Years of Membership Accomplishments

36. Special Skills or Talents:

37. Food Restrictions: 38. Allergies

39. Dialect(s) or Foreign Language(s) Spoken:

40. Title of Seminar/Training Course Attended Inclusive Dates No. of Hours Conducted by

41. Previous Work Experience

Name of Company Position Inclusive Dates Salary

42. Character References: [not related to you within the third degree of consanguinity]

Name 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: ________________________________________________________________________

45. Have you been a participant of any NYC International Exchange Program? No 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 status51. 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, 4th Flr., Bookman Building, 373 Quezon Avenue,

Quezon City, Tel No. 4162833.Please fill out the form legibly