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CONFIDENTIAL

Form 1

1.

CURRICULUM VITAE

Please use a black or blue ball-point pen. Application documents and forms may also be downloaded and completed by PC.

FULL NAME (as written in your passport) Sur Name Given Name

RIVAI 2.

ANWAR

ADDRESS FOR CORRESPONDENCETELEPHONE BTN BATARA UGI BLOCK BO NUMBER 08 - +6285242092436

PHOTO 3.5cm4.5cm

MAIL ADDRESS RIVAI.TAMBANG09@GMAIL.COM

3.

NAME AND ADDRESS OF PERSON TO BE NOTIFIED IN CASE OF EMERGENCYTELEPHONE (Relationship to you)


()

ASNAH ANWAR BTN BATARA UGI BLOCK BO NUMBER 08 - +6285242092436 (SISTER)

4. 01 7.

DATE OF BIRTH
Month Year

Date

5. 21 8.

AGE

6.

SEX
FEMALE RELIGION

MALE NATIONALITY

12
MARITAL

1990
STATUS

9.

SINGLE

MARRIED

INDONESIAN
/

ISLAM

10. UNIVERSITY OF CURRENT ENROLLMENT

NAME OF INSTITUTION

CITY / COUNTRY

MAJOR SUBJECT

SOUTH SULAWESI INDONESIA 11. LANGUAGE PROFICIENCY

HASANNUDDIN UNIVERSITY

MINE ENGINEER

Please, place an X at the level corresponding to your grade of language proficiency test or equivalent. Score ENGLISH EXCELLENT POOR NOT AT ALL GOOD

JAPANESE

NOT AT ALL Personal information contained in application documents will be used for [1] all manner of contact from application to program completion and return to home country, and [2] creating statistical documents that summarize the results of the program.

EXCELLENT

GOOD

POOR

Score

CONFIDENTIAL
Form 2-1

Application Form
To: Yozo Kaneko, President, Japan Overseas Cooperative Association I wish to participate in the Youth-Exchange Project with Asia-Oceania and North America (Kizuna (bond) Project) Long-term Invitation Program that your association is implementing. I consent to the attached Terms and Conditions, and I hereby make my application with the relevant documents attached. SURNAME
RIVAI

GIVEN NAME COUNTRY

ANWAR

NATIONALITY INDONESIAN

INDONESIA

MAIL ADDRESS (for notification of acceptance into the program)


RIVAI.TAMBANG09@GMAIL.COM

1.

Desired Training Course Name of Course (A,B,C,D) 1st choice D Name of University, if C or D course HASANNUDDIN UNIVERSITY

2nd choice C 3rd choice B

HASANNUDDIN UNIVERSITY

CONFIDENTIAL
Form 2-2

SURNAME RIVAI

GIVEN NAME

ANWAR

2. What are you currently studying at your university or school? I CURRENTLY STUDYING AT FACULTY OF ENGINEERING FOCUSING ON MINING MATTERS AT HASANNUDDIN UNIVERSITY

3. What would you like to study about in Japan? BASICLY ITS ABOUT THINGS THAT I WATCH ON DAILY JAPANESE CARTOON, LIKE DORAEMON AND ETC, I REALLY INTEREST ON JAPANESE CULTURE, ABOUT THEIR DAILY LIFE, ABOUT HOW THEY PURSUE THEIR DREAMS, HOW THEY SOLVE THIER PROBLEMS, HOW THEY RELIEF FROM A DISASTER LIKE AN EARTHQUAKE, TSUNAMI ETC.

4. What are your aspirations for participating in this program? IS IT BASICLY THE LONG TERM GOAL, BECAUSE I HOPE THAT WHEN IT COMES TO MY COUNTRY, WHEN THAT DISASTER HAPPEN I KNOW WHAT SHOULD I DO FOR MY COUNTRY AFTER I LEARN FROM JAPANESS PEOPLE,ABOUT HOW TO FACING THAT KIND OF THINGS

5.

Why would you be a good choice for this program?

BECAUSE I HAVE A MISSION, ALL THE DISASTER LIKE TSUNAMI, EARTHQUAKE WHICH ALREADY HAPPENED IN JAPAN ALSO HAPPENED IN MY COUNTRY, THE CASUAL VISUAL FOR THIS DISASTER HAVE A HUGE NUMBER IN INDONESIA,I MEAN THE NUMBER OF VICTIMS OF THIS DISASTER IS VERY HUGE. NOT ONLY ME BUT ALSO THE WORLD KNOW, HOW JAPANESE GOVERNMENT AND ALSO THE PEOPLE CAN RAISING UP AGAIN THEIR HOPES, AND THEY PROVE THAT THEY CAN MOVE ON IN A VERY QUICK TIME. THE GOVERNMENT ALSO QUICKLY RELIEF THE SPIRIT OF THEIR PEOPLE FROM THIS DISASTER . AND MY MISSION IS TO LEARN THAT PARTICULAR THINGS TO BE ABLE TO MAKE IT RETURN BACK TO MY COUNTRY

CONFIDENTIAL
Form 2-3

SURNAME RIVAI

GIVEN NAME

ANWAR

9.

How are you planning to relay the results of this program to the people in your country after you finish participating in it? I WILL INVOLVE MY SELF IN SEVERAL STUDENTSORGANIZATION IN MY FACULTY, IN MY UNIVERSITY, GETTING CLOSER WITH COMMUNITY AROUND ME, BECAUSE MY MAJOR STUDY FOUCSING ON MINE AND SOME THINGS ABOUT GEOLOGIST, ILL USE MY KNOWLEDGE AS A GEOLOGIST AS A TOLS TO SPREAD THE VALUES OF THIS PROGRAM, START FROM MY FAMILY, FRIENDS AROUND ME. WITH THIS EXPERIENCE ILL USE ON MY WORK PLACE LATER LIKE REGARDING THE COMMUNITY SERVICES, ILL TELL THE PEOPLE, ILL SPREAD THE VALUES OF EVERY LILTTLE THING THAT I GET FROM THIS PROGRAM, START FROM MY LITTLE COMMUNITY , MAKE A SOCIALSATION OF DISASTER RELIEF PROGRAM, AND FROM THAT THEY WILL SPREAD IT AGAIN, NOT ONLY BY ME BUT BY THEM TO OTHER AS WELL.

10. How would you like to utilize the experiences you had in Japan after this program finishes? LIKE WHAT I MENTION ABOVE, I WANT THIS BECAUSE I WANT TO LEARN, I WANT TO GET EXPERIENCE, SO I CAN SPREAD IT OUT TO MY FRIENDS, MY COMMUNITY AND TO THE DIFFERENT LEVEL IS TO MY COUNTRYBUT I KNOW THAT I HAVE TO DO IT STEP BY STEP, ILL START FROM MY FRIENDS, IS NOT THAT HARD TO ...HOW TO REACT TO A DISASTER

CONFIDENTIAL
Appendix

Terms and Conditions


Yozo Kaneko, President, Japan Overseas Cooperative Association If I am chosen as a participant in the program, I agree to devote myself to the program while strictly adhering to the following. 1 2 3 4 I will observe the laws of Japan and the rules of the accepting institution, and behave myself as a good participant. I will faithfully follow the instructions and decisions of the implementation group and the university. I will redeem on my own responsibility any obligations incurred due to deliberate or flagrant delinquency. In the event that any of the following are deemed to apply and I am ordered to leave the program, I will return to my home country at my own expense in accordance with such order. (1) It is impossible to continue the program for reasons of my deliberate or flagrant delinquency or negligence (2) I decide to quit the program at my own discretion (3) I commit an act that disturbs the order of society (4) A false statement is discovered in the information filled out in an application document I will promptly return to my country after the prescribed program ends, and I will utilize the knowledge and experience I have gained to actively disseminate such information to my local community. End of document

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