Professional Documents
Culture Documents
Official Mailing Address: 259 C-13 Genito Apartments, Tandang Sora, Quezon City (1116)
Residence Address: 259 C-13 Genito Apartments Tandang Sora, Quezon City
Passport No.: _______ Date of Expiry: _______ Tel. No. (landline/Area Code): _____
Character References: [not related to you within the third degree of consanguinity]
Important: Please call or text the SSEAYP Secretariat from May 1, 2010 to get your schedule for the regional interview. Please indicate
your whole name and the region you are representing. [SSEAYP Secretariat Tel. Nos. 781-2386;781-2372 or 743-9399;
Cell # (0920-9181297)]
All facts and data given in this information sheet will be treated with utmost confidentiality
Please name any SSEAYP Alumni you know Relationship
Have you previously applied for SSEAYP? No Yes How many times?
How did you know about the program? Have you been a participant of any NYC International Exchange
Newspaper: _____ Radio: ______ Program? [ ] No [ ] Yes
Have you been involved with any NYC local program or activity? [ ] No [ ] Yes If yes, please indicate the program(s) and year.
If no, are you willing to enter into a MOA with NYC to render voluntary work for its programs and activities?
Have you joined or attended any SSEAYP activities? [ ] No [ ] Yes If yes, please indicate
Have you availed of any program or scholarship grant offered by the Japanese government? [ ] No [ ] Yes If yes, please indicate the program and year
Have you attended any seminar, conference or trainings abroad? [ ] No [ ] Yes If yes, please indicate the program and year
Do you anticipate to take part in any program, conference, board/bar exams or scholarships this year? [ ] No [ ] Yes If yes, please indicate details
Are you on a scholarship granted by the Department of Science and Technology (DOST) and/or any other government agencies? [ ] No [ ] Yes
If yes, please indicate
Have you ever been convicted of any crime involving moral turpitude? [ ] No [ ] Yes If yes, please indicate the nature and status
Do you have any pending civil and administrative case? [ ] No [ ] Yes f yes, please indicate the nature and status (you will be required to present clearance).
SWORN 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 ground for expulsion in the SSEAYP and prosecution for perjury.
Further, I subscribe and agree that the National Youth Commission has the sole prerogative to select, reclassify and nominate the delegates to the Ship for
Southeast Asian Youth Program [SSEAYP], and its decision is final and executory. And if chosen, I will join the activities of the program such as Pre-
departure training (July 17-28), pre-departure activities (Sept. 25-Oct. 24), cruise (Oct. 25-Dec. 16) and post-program evaluation (Dec. 16-18).
IN WITNESS hereof, I am executing and signing this statement voluntarily without compulsion.
_____________________________
Signature
NOTE:
Non-extendible deadline for submission of application form is 5:00 o’clock pm on April 16, 2010.
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 Ms. Marielou A. Chua, National Youth Commission, 4th Flr., Bookman Building, 373 Quezon Avenue, Quezon
City, Tel Nos. 781-1617/781-1152/781-1406/749-9401/749-9404/749-9409/749-9399 locals 113 and 115.
Please fill up the forms legibly [pls. Photocopy and submit 8 copies]