APPLICATION FORM

AUSTRALIA-INDONESIA YOUTH EXCHANGE PROGRAM 2010-2011

SECTION A: Personal Particulars 1. 2. 3. Surname: Given Names: Permanent home address:

4.

Telephone numbers:

Business Hours: After Hours: Fax Number: Email Address:

5.

Mailing address and telephone number:

NB:

We may need to contact you during and after the selection process. The above mailing address and telephone number should enable us to do so quickly.

6. 7. 8.

Date of Birth: Place of Birth: Are you an Australian Citizen?

Please enclose a copy of your birth certificate or citizenship certificate showing that you are an Australian citizen.

9.
(Optional)

Marital Status:
Your marital status has no bearing on the selection process. However, you should be aware that participants in the Program cannot be accompanied by spouses or dependants.

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10. Next of kin: Name: Relationship: Address: Telephone numbers: Business hours: After hours: Fax number: 11. How did you hear about the Australia Indonesia Youth Exchange Program? University Notice Boards Websites Other: ____________________________ SECTION B: Education and Employment History Education: 11. Please give details of completed secondary and tertiary study. Name of Institution Date of enrolment Award received

Please attach certified transcripts of school, college or university records. These should be statements from the institution showing the subjects studied in each year, together with the results achieved. 12. Please give details of any course and subjects in which you are currently enrolled. Name of Institution Date of enrolment Expected completion

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13. LANGUAGE SKILLS: Please give details of any Indonesian language studies, including your proficiency in speaking, reading and writing Indonesian.

Employment: 14. 15. Present occupation: Work experience (please list most recent work experience first):

16.

Describe briefly the nature of your work in each of these positions:

17.

How do you see your particular skills/knowledge relating to the Program?

18.

Living in Indonesia may be a new experience for you. Please describe why you expect to be able to adjust successfully to different environments and living conditions in a foreign country, as well as the physical and emotional demands that you perceive the Program may entail.

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19. Past Programs have demonstrated the requirement that participants adapt to, and accept, markedly different social and interpersonal customs and forms of conduct. This includes substantial constraints on customary Australian social and behavioural habits. What are your views on this?

20.

As representatives of Australia in Indonesia, participants can be expected to answer questions about Australia and to speak in public, as well as participate in cultural performances by the Australian group. How would you relate to this?

NB: Please list any additional interests/activities in which you participate, highlighting any aspects which you believe may be relevant to your participation in this Program, e.g. cultural performance, musical, sporting skills.

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STATEMENT BY APPLICANT A. I declare that the information contained in this application is complete and accurate to the best of my knowledge. I have read the information provided to me about the Australia-Indonesia Youth Exchange Program 2010-2011, and I am willing to participate in the Program on this basis. I have read and understand the contents of the Australian Government Travel Advice for Indonesia, at www.smartraveller.gov.au, and have taken an independent decision to apply to be a participant on the Australia-Indonesia Youth Exchange Program 2010-2011. I understand that the participants in the program are expected to represent Australia for the duration of their participation in the Program. I agree to abide by all Australian and Indonesian laws and regulations and all instructions from the Australian and Indonesian Coordinators for the duration of my participation in the Program. I understand that Australian participants cannot be accompanied by their spouses or dependants for any part of their stay in Indonesia. I understand that should I be selected for the Australia-Indonesia Youth Exchange Program 2010-2011 I will be required to sign a Deed Poll irrevocably waiving any current or future claim against the Australia-Indonesia Institute or any director, member, employee, contractor or associate of the Australia-Indonesia Institute in respect of my travel to Indonesia.

B.

C.

D.

E.

F.

G.

Signature of applicant: Signature of witness: Name of witness: Occupation:

Date: Date:

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APPLICATION FORM AUSTRALIA-INDONESIA YOUTH EXCHANGE PROGRAM 2010-2011

STATEMENT OF PURPOSE: Please attach a one-page statement describing why you have applied to participate in the Australia-Indonesia Youth Exchange Program 2010-2011. You should indicate the benefits that you expect to gain from participation in the scheme, how this relates to your career aspirations, and what you feel you would contribute as a team member of the Australian group and overall to the success of the exchange PHOTOGRAPHS: Please enclose two identical passport-size colour photographs taken within the last year. Your full name must be printed on the back of each photograph. REFEREES: You are required to submit two or three references with this application. One referee should be able to comment on your educational achievements and, where applicable, one referee should be able to comment on your recent work performance. References should be attached to this application or forwarded separately to reach the Australia-Indonesia Institute by 2:00pm AEST Wednesday 28 July 2010.
NB: Please note that while the Selection Committee may approach your referees for further comment on their written assessments, obtaining references is the responsibility of the applicant and the Committee will not prompt your referees to forward their comments.

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APPLICATION FORM AUSTRALIA INDONESIA YOUTH EXCHANGE PROGRAM 2010-2011

Completed applications, in hard copy for m and an electronic version on disk, should be forwarded to reach the Australia-Indonesia Institute no later than: 2:00pm AEST Wednesday 28 July 2010 .

AIYEP 2010-11 Australia-Indonesia Institute PO Box 5369 KINGSTON ACT 2604 Facsimile No: E-mail: (02) 6112 3821 ausindonesia.institute@dfat.gov.au

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