Part I: Please choose a Group Theme you are interested in. 1. Good and Bad Aspects of Globalization 2. Information and Media 3. International Relations (ASEAN-Japan Cooperation) Discussion 4. Living in the Longevity Society Group 5. Quality Education Theme 6. Resilient and Sustainable City Design 7. Soft Power and Youth Private Diplomacy 8. Use of Affordable, Reliable and Sustainable Energy Services Part II: Personal Information Name: (Photo) Nationality : Gender : Upper half body Female Male No hat Date of Birth : / / Age: Plain background (DD/MM/YYYY) Within the past six Experience of SSEAYP : Year Batch months Address : Contact Information: Home Phone : Fax : Mobile Phone : Email : Employee ( Government Private NGO/NPO) Self-employed Teacher Student Occupation : Other ( ) Position : Name : Office/School: Address : Phone : Fax : Final Schooling : Major field : Language : English : (test score: ) - indicate test score Others : Special skills (if any) : Experience of residence Yes (Date and Purpose: ) in : No *excluding SSEAYP Non-halal food Meat ( Beef Pork Chicken ) Alcohol Food Religion Others ( ) Restriction Vegetarian Meat Fish Egg Dairy Others ( ) (What you Allergy don’t eat) Others Case history: Prescription (drugs, injection, etc): Health Issues Allergy to medicine: Smoking: Yes No
Part I: Please choose a Group Theme you are interested in. Discussion Group Theme 1. Good and Bad Aspects of Globalization 2. Information and Media 3. International Relations (ASEAN-Japan Cooperation) 4. Living in the Longevity Society 5. Quality Education 6. Resilient and Sustainable City Design 7. Soft Power and Youth Private Diplomacy 8. Use of Affordable, Reliable and Sustainable Energy Services Part II: Personal Information Name: (Photo) Upper half body No hat Plain background Within the past six months Nationality : Gender : Female Male Date of Birth : (DD/MM/YYYY) / / Age: Experience of SSEAYP : Year Batch Contact Information: Address : Home Phone : Fax : Mobile Phone : Email : Occupation : Employee ( Government Private NGO/NPO) Self-employed Teacher Student Other ( ) Position : Office/School: Name : Address : Phone : Fax : Final Schooling : Major field : Language : - indicate test score English : (test score: ) Others : Special skills (if any) : Experience of residence in : *excluding SSEAYP Yes (Date and Purpose: ) No Food Restriction (What you don’t eat) Religion Non-halal food Meat ( Beef Pork Chicken ) Alcohol Others ( ) Vegetarian Meat Fish Egg Dairy Others ( ) Allergy Others Health Issues Case history: Prescription (drugs, injection, etc): Allergy to medicine: Smoking: Yes No