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The 16th ASEAN-Korea Future-OrientedYouth Exchange Programme:
ASEAN-Korea Youth Square Seoul & Gangwon-do, Korea / 5 to 10
February 2015
Please complete this form based on your passport. (The title of
e-mail should be 'ASEAN-Korea_name of participant')
Personal Information
First Name:DayangPHOTO HERE
Last Name:Putri
Full Name (with Middle Initial):Dayang Anindya Wahyu Putri
Gender (Female/Male):Female
Nationality as shown on passport:Indonesia
Year of Birth (YYYY-MM-DD):11/9/93
Passport Number:
- Date of Expiry:
Religion:Islam
Contact Information
Current Address:Perumahan Benua Indah Blok A5 no.17 rt/rw
005/009, kel. Pabuaran Tumpeng, Kec. Karawaci, Tangerang-Banten
City:Tangerang
Country of residence:Indonesia
Contact e-mail:[email protected]
Telephone with country code (e.g.
82-2-000-000):62-812-9810-7239
Mobile with country code:62
Additional Information
Name of your latest school (or work) :UIN Syarif Hidayatullah
Jakarta
English proficiency (Advanced/Native):native
Preferred t-shirt sizeM
Special Requests & Medical Conditions
Prohibited food(s):pork
Allergies to (food, medicine, plant, and etc):fish were not
fresh
If you are on special medication, let us know:nothing
Why should you be selected ?want to try something new, and wants
proud my parents :)
![[Form] ASEAN-Korea Youth Square.xlsx](https://img.pdfslide.net/doc/110x75/563dba27550346aa9aa32457/form-asean-korea-youth-squarexlsx-566b27b8ed370.jpg)
