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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:MuhammadPHOTO HERE

Last Name:Ihsan

Full Name (with Middle Initial):Muhammad Faris Ihsan

Gender (Female/Male):Male

Nationality as shown on passport:Indonesia

Year of Birth (YYYY-MM-DD):29/08/1994

Passport Number:A 4806697

- Date of Expiry:5/2/18

Religion:Islam

Contact Information

Current Address:Bumi Jatiwaringin Street Area G Number 3 City:Bekasi

Country of residence:Indonesia

Contact e-mail:farisihsan94@yahoo.com

Telephone with country code (e.g. 82-2-000-000):62-21-8461729

Mobile with country code:62-85710004453

Additional Information

Name of your latest school (or work) :42 Senior High School

English proficiency (Advanced/Native):Advanced

Preferred t-shirt size L

Special Requests & Medical Conditions

Prohibited food(s):-

Allergies to (food, medicine, plant, and etc):-

If you are on special medication, let us know:-

Why should you be selected ?Because I have an idea which might be alternative solution of national problems, such as professor teaches children in elementeary school ,character building and nation with fun learning in elementary and junior high school. So with several of idea I want to share and discuss with other young people of the world ,to change our world more beautifull of inovation idea and creation from young people.

mailto:farisihsan94@yahoo.com