Please check the box of your category:

Economics & Social Sciences

Science & Technology
Arts, creative works & culture

Annex 1

JENESYS 2.0 APPLICATION FORM Please paste a most

recent photo
1. Title of JENESYS Project being applied for:
ASEAN Economic Community (AEC) Youth Network

2. Expected commencement of the program:

26 May 2013 to 2 June 2013

3. Name of Participant:

Given name Middle name Family name

4. Nationality:

5. Date of Birth: Age:

6. Home Address:

7. Email:

8. Home phone number: Hand phone (if any):

9. Name of Present School:

10. Grade: Year entered:

11. Major studies:

12. Passport number: Date of Issuance:

Date of expiry:

13. Travel to Japan: Have you ever visited Japan before? Yes No

If yes, when did you visit Japan?

1
14. Participation in JENESYS: Have you participated in JENESYS before?

Yes No

15. Have you participated in other scholarship/visit Japan program different from
JENESYS? If yes, please explain what the name of the program was and when it
was organized.

16. Please explain about your Achievements/Awards/Outstanding Talents/Extra-

curricular Activities:

17. Please explain briefly about your personality and what career you wish to pursue
in the future.

2
 18. Please explain your views and impressions about Japan and share your plans to
contribute to closer friendship between ASEAN and Japanese peoples by
participating in this program.

Date of Application: Signature of Applicant:

__________________ _______________________