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 12:00 noon (WIB), Wednesday, August 13, 2014 by e-mail
Name
Attach your photo
here

Date of
Birth

First Name

dd/mm/yyyy

Country
of Birth
Contact
Information

Middle Name

Family Name

Age (as of
Aug. 31,
2014)

Sex

Citizenship

Current
Home
Address
Mobile

Telephone

University or Graduate School

E-mail
Major
Faculty
Batch

Information about
Affiliation

Address

Telephone
Fax
E-mail

Prefered Address
Language
Proficiency
How did you learn
about Hope and
Dreams (HANDs)
Program?

Oversea Travel /
Study Experience
(if any)

Please indicate which address you would like to use for correspondence:
( ) at home ( ) at university
English Proficiency Certification (if any)
Type

Score

English Level
( ) Fluent ( ) Fair ( ) Poor

Oversea Travel /
Study Experience
(if any)

Briefly explain
about yourself,
including your
background,
personality, as
well as your
volunteer /
internship /
professional
experience (750
words maximum)

Briefly explain
about your
experience in
disaster-related
activities (500
words maximum)

Briefly explain
about your
motivation in
joining HANDs
Program. Why do
you think you
should be
selected? (750
words maximum)

Program. Why do
you think you
should be
selected? (750
words maximum)

In the HANDs Program 2014, the participants are expected to create a disaster education related program
as a group, that will be implemented in 2015. 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)

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

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.)

Please attach to this application form the following documents

1. Curriculum Vitae in English. This must not exceed 5 pages in length.

2.Any additional materials about your disaster related activities

NDs) Projects

must be submitted to HANDs

14 by e-mail
Family Name

( )M
( )F

use for correspondence:

sity
English Level

) Fluent ( ) Fair ( ) Poor

ster education related program

out disaster education related
. Please specify 1) your target
nicate it. Please tell us how you
ds maximum)

gnature in case that it is not