APPLICATION FORM

AUSTRALIA-INDONESIA YOUTH EXCHANGE PROGRAM 2012-2013

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

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.

Australia Indonesia Youth Exchange Program 2012/2013 Page 1 of 8

APPLICATION FORM
6. 7. 8. Date of Birth: Place of Birth: Are you an Australian Citizen?
Please enclose a copy of your birth certificate, passport or citizenship certificate showing that you are an Australian citizen.

9.

Next of kin: Name: Relationship: Address: Telephone numbers: Business hours: After hours: Fax number:

10.

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

Australia Indonesia Youth Exchange Program 2012/2013 Page 2 of 8

APPLICATION FORM

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

Australia Indonesia Youth Exchange Program 2012/2013 Page 3 of 8

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

Employment: 14. Present occupation:

15.

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?

Australia Indonesia Youth Exchange Program 2012/2013 Page 4 of 8

APPLICATION FORM

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.

Australia Indonesia Youth Exchange Program 2012/2013 Page 5 of 8

APPLICATION FORM

Australia Indonesia Youth Exchange Program 2012/2013 Page 6 of 8

APPLICATION FORM

Australia Indonesia Youth Exchange Program 2012/2013 Page 7 of 8

APPLICATION FORM
19. 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. Please outline your ability to meet this requirement.

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.

20.

Do you have any pre-existing health conditions that could possibly affect your participation in the Program if selected? If so, you must provide details including whether you are receiving any treatment or medication. You may attach a report from a professionally qualified health practitioner.

Australia Indonesia Youth Exchange Program 2012/2013 Page 8 of 8

APPLICATION FORM

NB:

Where theres a pre-existing condition its important that it is manageable given the living and village environment of Indonesia.

STATEMENT BY APPLICANT A. B. I declare that the information contained in this application is complete and accurate to the best of my knowledge. I have read all the information provided to me about the Australia-Indonesia Youth Exchange Program 2012-2013, 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 2012-2013. I understand that the participants in the program are expected to favourably 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, dependants or friends for any part of their stay in Indonesia. I understand that should I be selected for the Australia-Indonesia Youth Exchange Program 2012-2013, 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.

C.

D. E.

F. G.

Signature of applicant:

Date:

Australia Indonesia Youth Exchange Program 2012/2013 Page 9 of 8

APPLICATION FORM
Signature of witness: Date:

Name of witness:

Occupation:

Australia Indonesia Youth Exchange Program 2012/2013 Page 10 of 8

APPLICATION FORM

AUSTRALIA-INDONESIA YOUTH EXCHANGE PROGRAM 2012-2013

STATEMENT OF PURPOSE: Please attach a one-page statement describing why you have applied to participate in the Australia-Indonesia Youth Exchange Program 2012-2013. 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 accompany or be printed on the back of each photograph. REFEREES: You are required to submit two 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 5:00pm (AEST) Wednesday 29 August 2012.
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.

Australia Indonesia Youth Exchange Program 2012/2013 Page 11 of 8

APPLICATION FORM AUSTRALIA INDONESIA YOUTH EXCHANGE PROGRAM 2012-2013

Completed applications, either emailed or sent in hard copy, should reach the Australia-Indonesia Institute no later than:
5:00pm (AEST) Wednesday 29 August 2012.

AIYEP 2012-13 Australia-Indonesia Institute R G Casey Building John McEwen Crescent BARTON ACT 0221 Facsimile No: E-mail: (02) 6261 1743 ausindonesia.institute@dfat.gov.au

Australia Indonesia Youth Exchange Program 2012/2013 Page 12 of 8