Global Youth Leaders Travel and Learning Camp 2015________________________________________________________________

Application Form (Participants)

Please note that all fields with asterisk* are compulsory.Should you have any queries, please feel free to contact our Participant Services Officers atps@gyltlc.org

A. Personal Information (Please write in BLOCK letters)

Name (as in Passport)*Last Name (Surname) *MILLAN

GENEVIEVE MILLANFirst Name *GENEVIEVE

Date of Birth * (DD/MM/YY)18 / 02 / 96Gender*

Nationality*FILIPINO

Passport No*

Country of Issue*Date of Expiry* (DD/MM/YY) : / /

B. Contact Information

Email Address*genevieve_millan@yahoo.comAlternative Email Address*genevieve_millan@yahoo.com

Contact Number *(Country Code Area Code Phone Number)+639293069342

Mailing Address*Jalandoni St. Zarraga, Iloilo Ph

Zip/Postal Code*5004Country*Philippines

Emergency Contact Person*Relationship with Applicant*

Emergency Contact Number*(Country Code Area Code Phone Number)

C. Health Declaration (For statistical purposes only and not as selection criteria)

Allergies*none

Major Medical Problems*none

Medication Currently Taken*none

Dietary requirements (Halal, vegetarian etc)none

Others

D. Educational Background

University/School Name*University of the Philippines Visayas

Major/Minor*BS in Management

Year of Study*2

E. Knowledge of Languages

Please select (X) to indicate your English proficiency with 1 being lowest and 6 being highest.

English*123456

|_||_||_||_||X||_|

Native Language Hiligaynon

F. Family Particulars

Family Member 1*

Name*Relationship with Applicant*

Occupation*Contact Number*(Country Code Area Code Phone Number)

Family Member 2*

Name*Relationship with Applicant*

Occupation*Contact Number*(Country Code Area Code Phone Number)

G. Experiences/Achievements

Co-curricular Activities (eg. Clubs or Societies, Sports, Performing Arts)

Hobbies and Areas of Interest

Previous and/or current participation in community / volunteering service, if any (please describe briefly)

Awards/Scholarships (if any)

Other experiences (if any)

H. Personal Statements

Please answer the following questions in no more than 200 words each.

Why do you want to apply GYLTLC 2015? *

Tell us about an achievement that you are most proud of. *

I passed the UPCAT (University of the Philippines College Admission Test)

Tell us about a challenge you have faced as a student leader and how you overcame it *

What else would you like us to know about you? *

Declaration

I hereby declare that the particulars provided are true to the best of my knowledge and that I have not willfully suppressed any material facts. I understand that misrepresentation or omission of any materials required in this form will be sufficient cause to terminate myposition if I have been chosen. I authorize you, your subsidiaries and affiliates, and your authorized agents, to verify all information contained in this application and any supplement hereto.

Global Youth LeadersTravel and Learning Camp 2015

(Please insert your signature image here)

Signature: Date (DD/MM/YY) / /

Required DocumentPlease attach and send all the required documents listed below to: register@gyltlc.org. The subject line must be in the format of: Your Name _Country_ Application for GYLTLC 2015. Please ensure that all documents are submitted at the same time so as to prevent any confusion in processing your application. Please also ensure that you submit your forms and pay registration fee before the deadline.1. GYLTLC 2015 Application Form with signature (in Word.doc format only)2. Copy of your Certificate of Participation (Only for Alumni of Global Youth Leaders Travel and Learning Camp or Asian Youth Leaders Travel and Learning Camp)