All facts and data given in this information sheet will be treated with utmost confidentiality

44. Have you previously applied for any NYC International Exchange Program? † No † Yes How many times? ________________

If yes, please indicate the program/s and year/s: ________________________________________________________________________

45. Have you been a participant of any NYC International Exchange Program? † No † Yes How many times? _______________

If yes, please indicate the program and year: _______________________________________________________________________

46. How did you know about the program?

Facebook: _____ Twitter: ______

Website: _____ E-mail from NYC: ______

Others [pls. Indicate]: _____________________________________________________

47. Have you availed of any program or scholarship grant offered by any foreign government? [ ] No [ ] Yes

If yes, please indicate the program, year, and name of organizer

48. Have you attended any seminar, conference or trainings abroad? [ ] No [ ] Yes

If yes, please indicate the program and year _______________________________________

2016 Sizihwan International Conference on Asia-Pacific Studies

49. Have you been involved with any NYC local program or activity? [ ] No [ ] Yes

If yes, please indicate the program(s) and year ______________________________________

50. Have you ever been convicted of any crime involving moral turpitude? [ ] No [ ] Yes

If yes, please indicate the nature and status

51. Do you have any pending case? [ ] No [ ] Yes

If yes, please indicate the nature and status

STATEMENT

I hereby certify upon my honor that all facts and information indicated herein are true and correct to the best of my knowledge. I further declare that
any information given by me that is untrue may constitute a disqualification to any NYC programs.

The undersigned expressly authorizes the National Youth Commission or its representatives to use, share, and process my personal information I
have provided, shared, or declared in this form for any lawful purpose.

Further, I subscribe and agree that the National Youth Commission has the sole prerogative to select and nominate the delegates to any
International Program, and its decision is final and executory.

IN WITNESS hereof, I am executing and signing this statement voluntarily without compulsion.

_____________________________
Signature

______________________________
BEA CZARINA B. NAVARRO
Printed Name

NOTE:
ƒ The National Youth Commission reserves the right and prerogative to exclude applicants who will not meet the minimum requirements of the
Program. Lack or non-compliance of any of the above stated requirements will mean automatic disqualification without notice.
ƒ Mail or hand carry your application to the International Programs Unit, National Youth Commission, 3rd Floor, West Insula Building, 135 West
Avenue, Quezon City. Tel No. 4162833.
Please fill out the form legibly