Professional Documents
Culture Documents
Date of
Birth
First Name
dd/mm/yyyy
Country
of Birth
Contact
Information
Middle Name
Family Name
Age (as of
Aug. 31,
2014)
Sex
Citizenship
Current
Home
Address
Mobile
Telephone
E-mail
Major
Faculty
Batch
Information about
Affiliation
Address
Telephone
Fax
E-mail
Prefered Address
Language
Proficiency
How did you learn
about Hope and
Dreams (HANDs)
Program?
Oversea Travel /
Study Experience
(if any)
Please indicate which address you would like to use for correspondence:
( ) at home ( ) at university
English Proficiency Certification (if any)
Type
Score
English Level
( ) Fluent ( ) Fair ( ) Poor
Oversea Travel /
Study Experience
(if any)
Briefly explain
about yourself,
including your
background,
personality, as
well as your
volunteer /
internship /
professional
experience (750
words maximum)
Briefly explain
about your
experience in
disaster-related
activities (500
words maximum)
Briefly explain
about your
motivation in
joining HANDs
Program. Why do
you think you
should be
selected? (750
words maximum)
Program. Why do
you think you
should be
selected? (750
words maximum)
In the HANDs Program 2014, the participants are expected to create a disaster education related program
as a group, that will be implemented in 2015. Please explain your ideas about disaster education related
program that will benefit local communities and that you would like to create. Please specify 1) your target
population, 2) knowledge to be used, and 3) how to transfer/convey/communicate it. Please tell us how you
will contribute in realizing the project. Be creative! (750 words maximum)
I hereby certify that all the information given above is nothing but the truth.
Signature*
Date
(* If you are submitting this form by email, paste electric image of your signature in case that it is not
possible, just type your name.)
NDs) Projects
( )M
( )F
sity
English Level