4th

MINDANAO YOUNG LEADERS PARLIAMENT

Advancing and taking dynamic, pro-active steps in achieving the Mindanao Youth Agenda through PYDP 2012 - 2016
October 28 30, 2012 ARMM Compound, Cotabato City

APPLICATION FORM
Please fill out the form completely and properly and submit to mahamudlawoffice@gmail.com OR mylp2012@yahoo.com together with your resolution.
REGION: PERSONAL DETAILS First name: Middle name: Surname: Age: Sex: Birthdate: Religion:
CATEGORY OF DELEGATE

Nickname:

2 X 2 recent ID picture

In school Youth Out-of school Youth Working Youth Specific Youth Groups/ Youth w/ Special Needs Sangguniang Kabataan

CONTACT DETAILS Street number and name: City: Zip code: Email address (primary): Fax Number: Telephone Number (fixed line): Mobile Number: EDUCATIONAL BACKGROUND Have you ever attended school? What is your highest level of education? Non-formal College level Yes No Province:

Elementary Secondary

College graduate Graduate studies

ORGANIZATIONAL MEMBERSHIP Organization Inclusive Dates Position Held

INVOLVEMENT IN YOUTH/COMMUNITY RELATED ACTIVITIES Inclusive Dates Description

HOW DID YOU KNOW ABOUT MYLP? Newspaper Magazine Others: _________ DO YOU HAVE KNOWLEDGE IN PARLIAMENTARY PROCEDURES? Yes

Internet No

COMMITTEE MEMBERSHIP (Pls. rank according interest, where 1 is the highest) Sustainable Development Education Health Environment _______ _______ _______ _______ Employment/Entrepreneurship _______ Peace _______ Governance _______ Other relevant and emerging youth issues: (please specify) ____________________

YOU, MINDANAO AND the PHIL. YOUTH DEVT PLAN 2012 2016 Please answer the following questions briefly. 1. What is your aspiration for the Mindanao youth in relation with the PYDP 2012 -2016 and how do you plan to achieve this? (maximum of 150- 250 words) 2. Describe the kind of MINDANAO you want to have by the next ten (10) years. (maximum of 200 words)

CERTIFICATION I hereby certify that all facts and information listed herein are true and correct to the best of my knowledge. I further declare that any untrue and/or misleading information given by me may constitute a ground for non-inclusion in the Mindanao Young Leaders Parliament and prosecution of perjury. Further, I subscribe and agree that the Screening Committee of the MYLP2012 has the sole prerogative to select and nominate the delegate to the 4th MYLP, and its decision is final and executory.

I am willing to shoulder my travelling expenses necessary to ensure my participation to the activity. _______________________ Date accomplished ___________________________________ Signature of applicant

MYLP2012 advocates a paperless screening process as an environmental advocacy to save trees. Please submit this application to mahamudlawoffice@gmail.com OR mylp2012@yahoo.com together with your resolution not later than October 15, 2012. You will be notified by our Head of Screening Committee regarding the status of your application. Thank you very much and God bless.