APPLICATION FORM

INDONESIA PHILIPPINES YOUTH CULTURAL EXCHANGE PROGRAM 5

MANILA, 11 18 DECEMBER 2013
Please send back this application along withrecent color photo into
ayfn.hq@gmail.com with subject : Application of IPYCEP_your name

PERSONAL PARTICULARS
First Name
Last name/ Surname
Date of Birthday
Gender
Nationality
Country of residence
T Shirt size
Passport number. (if any)
Passport expire date (If

Margaretha
Marpaung
8th November 1994
MALE FEMALE
Indonesian
Indonesia
M

Any)
1.1 CONTACT INFORMATION
Address
Mobile phone number
Email
EDUCATIONAL INFORMATION
University/College/School
Academic Year
Field of study
LANGUAGE PROFICIENCY

082365564665
marpaungmargaretha@yahoo.co.id
Universitas Padjadjaran
2012
Agribusiness

Indicate your writing ability: No, Basic, Fluent, or Native.

Indicate your speaking ability: No, Basic, Conversational, or Native.
LANGUAGE
WRITING
SPEAKING
English
Indonesia

Basic

Conversational

Native

Native

EXTRACURRICULAR ACHIEVEMENTS
List down your extracurricular participations and achievements in

University and High school, with latest on the top.

EXTRACURRICULAR ACTIVITY
POSITON HELD
Thesis Writing
Crew-event
Generas day

program
Crew-event program

YEAR
2013
2013

HAVE YOU PARTICIPATED IN ANY OVERSEAS EXCHANGE PROGRAM

BEFORE?
List down all the programs that you took part in with year of participation.
NAME OF THE PROGRAM
YEAR OF PARTICIPATION
PERSONAL STATEMENT
1.7.1 Please tell us about yourself, your study, your family, future plan and
your dream (min 300 words)

My name is Margaretha Marpaung. Im the only child in my family and I lived

only with my mother and my maid in Medan. I treat my maid like my real
sister. My father died when I was one year old. My mother afforfds all of my
needs. She works hard to give me the best that she can do. She educates
me well to have a good attitude. She means everything to me. As a single
parent, she did her job very well until I grew up like this. I really love her. Im
gonna make her proud of having a child like me.
Since I was in the elementary school I really wanted to be a doctor. So I
studied hard during senior high school. I usually got first place in my class,
sometimes its going down to the third place. It only in class, not in parallel. I
also had an intensive course when I was in the 3 rd grade in the senior high
school. I tried my best when SNMPTN or we can call it selection into public
universities. There were two options, so i chose Faculty of Medicine in North
Sumatera University and the second i chose Faculty of Agriculture in

Universitas Padjadjaran. I really hoped I can entered Faculty of Medicine in

North Sumatera University because I really wanted to be a doctor and I
wanted to make my mom proud by passing the selection. I waited the result
for a month. I got nervoused everyday. Finally in the 12 th July 2012 the result
was announced. I saw it with my mom, my aunties and my cousins in my
house. We were really nervoused. I entered my examination number and we
prayed. Suddenly it appeared Congratulation for Your Succes Faculty of
Agriculture in Universitas Padjadjaran. I screamed loudly. First, I had to
thaknk God for what that he gave, but I really dissapointed when I knew the
result. I failed to be a doctor. Maybe its Gods way. I had to recieve what He
had given to me. I hoped in Agribussines I can become a success
entrepreneur, honest and work for God.
Now Im in the Faculty of Agriculture in Universitas Padjadjaran. I enjoy every
single day. I had a lot of experience. My major is Agribussines. I studied
about Acounting ,Economic, Management and everything which related with
Agriculture. I want to be a business woman and has a big salon. I also love
fashion. Having a boutique that exists in every part of Indonesia is my
dream.

1.7.2 Why would you take part at IPYCEP #5 . (In no more than 300 words)

I would like to take part in IPYCEP because I want to know Philippines culture
and to share my knowledge about Indonesias culture. Give each other the
new information from all delegation that participate in IPYCEP.

1.7.3 Please write down about your opinion on Philippines. ( min 250 words)

The arts of the Philippines reflect a society with diverse cultural influences
and traditions. The Malayan peoples had early contact with traders who
introduced Chinese and Indian influences. Islamic traditions were first
introduced to the Malays of the southern Philippine Islands in the 14th
century. Most modern aspects of Philippine cultural life evolved under the
foreign rule of Spain and, later, the United States. In the 16th century the
Spanish imposed a foreign culture based in Catholicism. While the lowland
peoples were acculturated through religious conversion, the Muslims and
some upland tribal groups maintained cultural independence. Among those
who were assimilated arose an educated elite who began to establish a
modern Filipino literary tradition. During the first half of the 20th century,
American influence made the Philippines one of the most Westernized
nations in Southeast Asia. The cultural movements of Europe and the United
States profoundly influenced Filipino artists, even after independence in
1946. While drawing on Western forms, however, the works of Filipino
painters, writers, and musicians are imbued with distinctly Philippine

themes. By expressing the cultural richness of the archipelago in all its

diversity, Filipino artists have helped to shape a sense of national identity.
Many Malay cultural traditions have survived despite centuries of foreign
rule. Muslims and upland tribal groups maintain distinct traditions in music,
dance,

and

sculpture.

In

addition,

many

Filipino

artists

incorporate

indigenous folk motifs into modern forms.

GENERAL
PLEASE DESCRIBE ANY SPECIAL DIETARY REQUIREMENTS IF NEEDED.
PLEASE STATE YOUR BLOOD TYPE.
o
INDEMNITY FORM

I, Margaretha Marpaung, hereby declare that I am participating in the Indonesia

Philippines Youth Cultural Exchange Program in Manila, the Philippines of my own
free will and volition, having understood the risks involved in the above mentioned
activity. I shall not hold the organizers of the above mentioned activity, namely the
Asean Youth Friendship Network Indonesia and Ateneo Student Exchange
Council Manilaresponsible in any way for my death, injury or disability or any loss
or damage whatsoever arising from any cause in connection with the activity or my
participation therein.
SIGNATURE:

DATE: 14th November 2013

PARENTAL CONSENT FOR PARTICIPANT BELOW 20 YEARS OLD

I, Suriana Aritonang hereby allow my child/ward* to participate in the above

activity, having understood the risks involved in the above mentioned activity. I
understand and agree that I will have no claim whatsoever and howsoever against
the organizers, the Asean Youth Friendship Network Indonesia and local
organizerfor any injury or loss of any kind including loss of life that my *child/ward
may sustain during the whole period of the above mentioned activity.

SIGNATURE:

DATE: 14th November 2013

CONTACT INFORMATION(IN CASE OF EMERGENCY)

FIRST NAME:

Suriana

MOBILE NO:

081397003709

SURNAME:

Aritonang

RESIDENTIAL NO:

20218

E-MAIL:

ALTERNATIVE
NO:

SIGNATURE:

Ana

DATE: