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21-2/2O19-lC
Government of lndia
Ministry of Youth Affairs & Sports
Department of Youth Affairs
(lnternational Co-operation Cell)
Suo: Visit of lndian Youth Delegation to various countries during 2019- Nominations from IIMs-reg
Sir,
I would like to inform you that under the International Youth Exchange Programme conducted by
this Department, youth delegations are exchanged with various countries, to promote mutual
understanding of values and culture among the youth and to develop better relations.
2. For the ]'outh delegations to be sent to different countries this year, you are requested to forward
around 60 nominations (30 males and 30 females, not exceeding 6 from each IIUS) amongst the
meritorious Students (preferably final year) from various IIMs in the order of priority/preference.
Follol,ing points ma_r, be taken care of while forwarding the nominations:
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Under Secretary to the government of India
lefax No. 011-2338-6416 Email: icsecl02 ail. com
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GOVERNMENT OF INDIA
Ministry of Youth Affairs & Sports
Application Form
Paste your
unsigned recent
colour
photograph
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2. Aadhar No.
tll
3 Bank Account Number (With Bank Name) ( Write Account Number which is
linked with your Aadhar Number, start with the left most box and fill only
required number of boxes, leave rest blank):
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4. Name of Guardian :
5. Date of Birth :
5. Sex
Male Female
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8. Contact Details :
Telephone No. I I
I
Mobile No.
E-mail
Address
SC ST
Yes No
13. Religion
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14. Hobbies
16. lf any case pending against you in any court of law at the time of filling up
this form:
(Yes/No)
18. Languages(lndian/Foreign)known:
S.No. Read I
Write Speak
I
I
I
19. Whether worked with any youth related organization like NCC, NSS, NYKS,
other (please specify and enclose relevant documents thereoo ANY
DISTINGUISHED WORK DONE, if so, please state, clearly. (Max t50 words)
-J-
20 Describe briefly about your hobbies/extra curricular activities/area of
interest, which may be relevant for considering your application. (Max 150
words) :
21. Describe any achievement in the field of academics or any other field,
which is relevant for considering your application. (Max 150 words)
22. Describe what you would like to gain from this youth exchange programme.
(Max 150 words)
4-
23. Describe how you would like to use the experience of participating in this
programme after you return to your country. (Max 150 words)
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Part-B : (To be filled by the nominated Youth)
Undertakino
2. I also affirm that I have not visited any other foreign country under the
lnternational Youth Exchange Programme organized by the Ministry of Youth
Affairs and Sports, in the past.
(Signature)
Date
-b-
Part-C : (To be filled bv recommendinq official / orqanization)
(Signature)
Name :
Designation
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