Sending Program Pre-Application

WKESB/tm

i Complete name as appears in NSO birth certrflcate/passport: (Last / First / Middle) Complete home/mailing address: (House No., Street, Barangay, City/Municipality, Province) Home phonew/area code: | Name of Father/Legal Guardian (for minora): Mobile phone/s: Email/s:

1 1. PERSONAL INFORMATION

Birthdate: (mm/dd/yy) Region:

Gender Male Female Zip Code:

Name of Mother/Legal Guardian (for minors): Job/Occupation & Employer Name:

j Job/Occupation & Employer Name: | Work or Mobile Phone/s: Email/s: Passport issue date:

Work or Mobile Phone/s: Passport expiry date: Foods 1 cannot eat:

Email/s: City/Country issuing passport: Native/Foreign languages spoken:

1 Passport No. (if available):

\ <

Religion: Christianity 1 am aMergic to: Islam Other Family/relative who has participated in an AFS Program: Yes, 1 have an AFSer relative. IF yes, name of AFSer relative: AFS Programs: 1 learned about AFS through AFS returnee/alumni/volunteer School Complete school/company name: DFriends/relatives Dlntemet Relationship:

No. of Sibtngs (brothers/sisters): No, 1 don't have an AFSer relative. Program Name/Destination: Date/Month/Year of Departure:

OPrint (newspaper/brochure/oostert

OOther

II. SCHOOL/EMPLOYER INFORMATION

Complete school/company mailing address: (House No., Street, Barangay, Clty/Municipalty, Province) Complete name of school principal/administrator/immediate supervisor: Telephone/s: For student only: Year Level in June 2012 Fax: For student only: Avenge grade in previous school yean Email/s: For Teacher only: PRC License Number

Region:

Zip Code:

Mobile Phone/s: For Adult only: Marital Status & No. of dependents:

ill. AFS PROGRAM SPECIFIC IIY FORMATION

Core Program Duration: Program Content: a" a
r

Preferred AFS Patner:

Scholarship Information: B ACS Aao and tho Pacific Initiative (AAI) Scholarship B AES International Diversity Scholarship B AES Mabuhay ScholarGhip Kamenori Scholarship Year Program ^kennedy-Lugar Youth Exchange & Study (YES) Program, Tl months S Wiajro SM Program. 6 months Kizuna VS Program, 12 days Leighton Philippines Year Program Scholarship, 11 months Philippine Youth Leadership Program (PYLP, 5-4 weeks) Other

1 choose to go abroad on: j/ftear Program (YP) Semester (SM) Program Tri-mester (TP.) Program Intensive Program (IP) Very Short (VS) Program

t choose to start my travel on: January-June (SH cycle) ^July-December (NH cycle)

High school University Community Service Class Exchange Culture Study & Immersion Dance Eco-Tourism Educator English language Intensive Foreign language Internship Journalism Sports Teacher assistant Volunteer Other:

1 choose to go to an AFS destination/host country in: Asia Europe JZfKtorth America South America Africa My top 3 destinations are: 1. 2. 3.

Complete name as appears in NSO birth certificate/passport: (Last /First /Middle)

Program:

Pre-Application p. 2

Tell us about yourself: Introduce yourself (I.E, how you see yourself, your personality, your relationship with your family and friends, your responsibilities at home and at your school, list your favorites, interests and hobbies, organization memberships, volunteer initiatives, and indicate how often you pursue them, etc Please attach separate sheets, as needed.)

Tell us about your expectations (before, during & after) for the program that you are applying for:

Tell us about your goals or plans which are important to you; what is your chosen community service advocacy?

I hereby certify that all information provided in this application form are true and correct to the best of my knowledge and ability. Applicant's signature: (Additional signature of Parent/s or legal guardian is required, if applicant
is a minor.)

Date of application: (mm/dd/yy)

Date received by AFS voi/staff:

SUBMIT Online Applications at:

ATTN: SENDING PROGRAM
Unit 1607 K/F Antei Global Corporate Center No. 3 Dofla Julia Vargas Avenue, Ortigas Center 1600 Pasig City, Metro Manila, Philippines

https://www.afsgiobal.org/AFSGIobal/OnlineApplication

AFS InterculturaJ Programs Philippines Foundation, Inc.

Telefax: +62(2)584 2002 Email: info.ptiilippmesaafs.org Web: http://www.afs.ph Page 2 o f 2