IATSS Forum

Application Form
The 41st & 42nd Forums, 2007
 Application for 41st & 42nd IATSS Forum Program in 2007

1. Period (55 days)

41st IATSS Forum: *April – June, 2007

42nd IATSS Forum: *September – November, 2007

* Schedule subject to change

* Participation in either 41stor 42nd IATSS Forum

2. Participating Countries

Cambodia, Indonesia, Laos, Malaysia, Myanmar, Philippines, Singapore, Thailand, Vietnam

3. Allocation

41st IATSS Forum

Total number of participants: 18
Cambodia 2 Indonesia 2 Laos 2 Malaysia 2
Myanmar 2 Philippines 2 Singapore 2 Thailand 2
Vietnam 2

42nd IATSS Forum

Total number of participants: 18
Cambodia 2 Indonesia 2 Laos 2 Malaysia 2
Myanmar 2 Philippines 2 Singapore 2 Thailand 2
Vietnam 2

4. Qualification
• Applicants must be from one of the countries above.
• Applicants should be no more than 35 years of age.
• Applicants should have at least 2 years of fulltime professional job experience.

5. Application

1) Application period: from January 15 to April 30, 2006

2) Application documents
• IATSS Forum application form (A4 size)
• 4 photos (4 cm x 3 cm, name on the back)
• 2 reference forms (A4 size)
• Essay (A4 size)
• Certificate of English proficiency (if possible)
Instruction for Application Documents

1. Fill out the application form (page 4 and 5) and submit them with other necessary documents
listed below to your IATSS Forum Country Committee Secretary.

2. Fill out the application form in English in BLOCK LETTERS.

3. For questions 14 and 15 in the application form, please answer within the space provided.

4. Attach 2 letters of recommendation (reference form attached) from your employers, professors,
or teachers. One of them should be your direct supervisor at your present job.

5. Attach 4 recent photos (4cm×3cm) to the application form. These photos should be no more
than 6 months old. Write your name on the back of the photos. One photo should be pasted
(not stapled) to the form, and the other three photos should be put in the envelope.

6. Please write an essay, in English, with the given theme and format. Use the essay sheet provided
in this application form.

7. Attach a copy of a certificate indicating your level of English proficiency, if you have one.
(TOEFL, TOEIC etc.)
 Submit to your Country Committee Secretariat by April 30th, 2006 Ref. no. _________________
st nd
Application Form for 41 & 42 IATSS Forum in 2007
*Fill out this form in English, in BLOCK LETTERS.
*For No. 2, 5, 8, 12, and 16, circle the appropriate choice.

1. Full Name PHOTO

　　　　
2. Sex Male / Female 3. Nationality ________________________

4. Birth Date (Day/Month/Year)_________________________________________

5. Marital Status Single / Married

6. Current Home Address

Tel.: ___________________Fax: _________________　E-mail:

7. Office Address

Tel.: ______________________(Ext. ) Fax: ____________________ E-mail:

8. Occupation
Full name of company or organization

Occupation belongs to the (government / academic / private / other) sector.

Present position & division/department

Brief job description

9. Educational Background
State only degrees that you have already obtained or that are to be conferred before April 2007.
Year of graduation Full name of school City & Country Major Certification

10.Career over the past 5 years

From To Full name of company or organization
(Month/Year) (Month/Year) City & Country Occupation and position

/ /

/ /

/ /

/ /
11. Language Proficiency
Language Excellent Good Fair Certificate obtained
English
Other foreign language ( )

12. Have you ever been abroad? Yes / No

If yes, please list your destinations from the most recent.
Country Year & length of stay Purpose of visit

13. Write down types of volunteer work or social contribution activities that you have done so far, if any.
From To Description of the work or activities
(Month/Year) (Month/Year)

/ /

/ /

/ /

14. Write down the most critical challenge that you are currently facing in your work.
(Not your volunteer work, but your fulltime professional work)

15. State how you have been working to overcome the challenge above.
　

16. How did you know about the IATSS Forum program? [alumni / newspaper / magazine / TV / poster / your office / your
boss / website / other ( )]

Certification
I certify that the foregoing statements are true and complete to the best of my knowledge and understand
that any willfully false statement is sufficient to cause rejection of this application.

Date:

Signature and Name of Applicant:

(A)
 IATSS Forum Reference Form
(To be written in English in BLOCK LETTERS)

Applicant's Name : _______________________________________________________________

Position : _______________________________________________________________

Name of Referee : _______________________________________________________________

Position : _______________________________________________________________
Institution : _______________________________________________________________
Location : _______________________________________________________________

1. How long and in what capacity have you known the applicant?

2. Please give your personal evaluation of the applicant.

Signature ____________________________________ Date __________________________

Thank you for your time and attention.

 (B)

IATSS Forum Reference Form

(To be written in English in BLOCK LETTERS)

Applicant's Name : _______________________________________________________________

Position : _______________________________________________________________

Name of Referee : _______________________________________________________________

Position : _______________________________________________________________
Institution : _______________________________________________________________
Location : _______________________________________________________________

1. How long and in what capacity have you known the applicant?

2. Please give your personal evaluation of the applicant.

Signature ____________________________________ Date __________________________

Thank you for your time and attention.

Essay

Please follow the instructions below:

1: Read the concept of IATSS Forum in the IATSS Forum brochure.

2: Based on your understanding of the IATSS Forum concept, write an essay titled:
“How the experience of IATSS Forum would be an important step for me professionally
or personally”
3: In your essay, make sure to include the following things:
I. Specify some of your future professional or personal aims or ambitions.
II. State what you expect you can learn and experience at IATSS Forum and how you can
make use of those toward your future aims or ambitions.
4: Follow the format below.
Format: 1) 1 pageA4-size 2) Typed 3) Double-spaced 4) Print size 10
5) Font: Times New Roman 6) Write your name at the top of the page
5: Use the sheet provided in this application form.

Note: Essays longer than one page will not be evaluated.

Your name :

Essay: How the experience of IATSS Forum would be an important step for me professionally or personally.
Committees
<IATSS Forum Steering Committee>
Chairperson
Yasuhei Oguchi Chairman, IATSS
President Emeritus, Shibaura Institute of Technology
Members
Hideyuki Kita Association Member, IATSS
Professor, Faculty of Engineering, Department of Social Systems Engineering, Tottori University
Masahiro Yoshimura Managing Director, IATSS

< IATSS Forum International Advisory Committee>

The committee is composed of chairperson of each Country Committee and main members of IATSS Forum Steering Committee

< IATSS Forum Program Committee>

Chairperson
Hideyuki Kita Association Member, IATSS
Professor, Faculty of Engineering, Department of Social Systems Engineering, Tottori University
Members
Tsutomu Mizota Professor and Chair, Department of Social & Environmental Medicine, Institute of Tropical Medicine/Graduate School of Biomedical
Sciences, National University of Nagasaki
Fumihiko Adachi Professor, College of Contemporary Society and Culture, Kinjo Gakuin University
Nobuyo Kasuga Association Member, IATSS
Associate Professor, Department of Human Science, Shibaura Institute of Technology

< IATSS Forum Cambodian Committee>

Honorary Chairperson
Sum Manit Advisor to the Royal Government of Cambodia
Chairperson
Var Kim Hong Senior Minister, Advisor to the Royal Government of Cambodia in Charge of State Border Affairs
Members
Sau Sisovanna UNDP Project Coordinator
Chea Vandeth Cabinet Director of the Council of Ministers,
Advisor to the Deputy Prime Minister
Hang Chan Thon Dean of the Faculty of Science, Royal University of Phnom Penh
Observer
Yayoi Kishi Researcher/Adviser for Cultural Exchange, Embassy of Japan

< IATSS Forum Indonesian Committee>

Chairperson
Ridwan Gunawan President of Indonesian Motorcycle Association
Members
Suprapti Sumarmo Markam　 Professor, Faculty of Psychology, University of Indonesia
Observer
Teruhisa Goto First Secretary, Embassy of Japan
Advisor
Minoru Yamashita President Director, P.T. Astra Honda Motor

< IATSS Forum Lao Committee>

Chairperson
Vanhpheng Thammavong Deputy Chief, Cabinet of Lao People’s Revolutionary Youth Union
Vice Chairperson
Soukata Vichit Director General, Department of Environmental Quality Development and Promotion
Members
Khanchai Kiasrithanakorn 　 President, New Chip Xeng Co., Ltd.
Observer
Ayako Akamine Second Secretary, Embassy of Japan
< IATSS Forum Malaysian Committee>
Chairperson
Ahmad Nawawi Hj Ayob Professor Emeritus, Institute of Biological Sciences, University of Malaya
Members
Vice Chairperson
Ungku A. Aziz Royal Professor, Professor Emeritus, University of Malaya
Members
Robert Wong Lum Kong Managing Director and CEO, Boon Siew Sdn. Bhd.
Zuraidah Atan Advocate & Solicitor, Chambers of Zuraidah Atan

Observer
Koji Takahashi First Secretary, Embassy of Japan
Advisor
Yasuhide Mizuno Managing Director and CEO, HONDA Malaysia Sdn.Bhd.

< IATSS Forum Myanmar Committee>

Chairperson
Zaw Min Win Vice President, Union of Myanmar Federation of Chambers of Commerce & Industry (UMFCCI)
Vice Chairperson
Thaung Tin Vice President, UMFCCI
Members
Maung Maung Lay Joint Secretary General (1), UMFCCI
Tun Aung Central Executive Committee Member, UMFCCI
Sein Myint Central Executive Committee Member, UMFCCI
Hla Myint Joint General Secretary, Myanmar Industries Association (MIA)
Win Naing Executive Committee Member, MIA
Observer
Tomofumi Yokoyama Second Secretary, Embassy of Japan
Advisor
Kyaw Htin Advisor, UMFCCI / Visiting Professor, Yangon University

< IATSS Forum Philippine Committee>

Chairperson
Fortunato T. de la Pena Undersecretary for Science & Technology Services, Department of Science & Technology
Members
Ricardo M. Lantican Professor Emeritus, Department of Agronomy, University of the Philippines
Amelia C. Ancog Professor, Technology Management Center, University of the Philippines
Meneleo Carlos, Jr. President, Resins Inc.
Flordeliza R. Mayari Assistant Schools Division, Superintendent, Division of Marikina City Schools
Ricardo G. Sigua Associate Professor, National Center for Transportation Studies, University of the Philippines
Observer
Yoshihiro Kobari Researcher/Adviser for Cultural Exchange, Embassy of Japan
Advisor
Takashi Sekiguchi President & General Manager, Honda Cars Philippines, Inc.

< IATSS Forum Singaporean Committee>

Chairperson
Huang Hsing Hua Professor of Chemistry, National University of Singapore
Members
George Abraham Chairman and Managing Director, The GA Group Pte Ltd
Ong Toon Hui Director, Personnel Policy Department, Public Service Division, Prime Minister’s Office
Foong Hin Cheong Director, National Youth Council
Observer
Hirofumi Morikawa Director, Japan Information and Culture Centre, Embassy of Japan
Advisor
Kenichi Okamura Managing Director, Singapore Safety Driving Center Ltd.
< IATSS Forum Thai Committee>
Chairperson
Apiwat Sretarugsa Director General, Department of Environmental Quality Promotion, Ministry of Natural Resources and Environment
Vice Chairperson
Pornthip Puncharoen Deputy Director General, Department of Environmental Quality Promotion, Ministry of Natural Resources and Environment
Members
Teerapan Sattagowit President of Thai IATSS Forum Alumni
Observer
Etsuo Okuda Second Secretary, Embassy of Japan
Advisor
Adisak Rohitasune Senior Vice President, Asian Honda Motor Co., Ltd.

< IATSS Forum Vietnamese Committee>

Chairperson
Le Bo Linh Vice General Director, Institute of World Economics and Politics
Members
Vo Nhu Lanh Chief Editor, Saigon Times
Mai Duc Loc Director, Office of Science, Technology and Science, Da Nang City, Quang Nam
Pham Thu Hang General Director, Enterprises Development Fund, Viet Nam Chamber of Commerce and Industry
Observer
Yukitsugu Ono First Secretary, Embassy of Japan
Advisor
Hiroaki Funami Director General, Honda Vietnam Co., Ltd.
IATSS Forum Country Committee Secretariats
IATSS Forum Suzuka
7992 Ino-cho, Suzuka, Mie,
Japan 510-0201
Tel: 0593-70-0511 Fax: 0593-70-0505
Homepage: http://www.iatssforum.jp
Email: mail@iatssforum.jp
IATSS Forum Cambodian Secretariat
Secretary: Mr. Hang Chan Thon
c/o Royal University of Phnom Penh,
Room No. 103, Faculty of Sciences Bldg.,
Conf. of Russia Boulevard, Phnom Penh,
Cambodia
Tel: 855-23884320 Fax: 855-23880116
Email: caradvchthon@online.com.kh
IATSS Forum Indonesian Secretariat
Secretary: Mr. Marcel A. Tandei
c/o Astra Honda Motor Foundation,
Jl. Yos Sudarso, Sunter I, Jakarta 14350,
Indonesia,
P.O.Box 3009 JKT10001
Tel: (21) 6521985 / (21) 6518080 (Ext. 1900)
Fax: (21) 6521187 / (21) 6521411
Email: marcel.tandei@astra-honda.com
IATSS Forum Lao Secretariat
Secretary: Ms. Vanpheng Khounbolay
c/o Lao People’s Revolutionary Youth Union,
Phonthan Road, P.O.Box 736, Vientiane,
Lao P.D.R.
Tel/Fax: 416727
Email: vanhpeng@laotel.com
IATSS Forum Malaysian Secretariat
Secretary: Mrs. Violet Fernando
P.O.Box 1221, Jalan Pantai Baru,
59800 Kuala Lumpur, Malaysia
Tel: (03)79674400 Tel/Fax: (03)79577032
IATSS Forum Myanmar Secretariat
Secretary: Mr. Hla Myint
c/o Myanmar Industries Association
UMFCCI Building, 504-506 Merchant Street,
Kyauktada Township, Yangon, Myanmar
Tel/Fax: 95-1-241919
Email: mia@myanmar.com.mm
IATSS Forum Philippine Secretariat
Secretary: Ms. Corlita G. Canilao
c/o Department of Science and Technology,
General Santos Avenue, Bicutan, Taguig, Metro
Manila, P.O.Box 3596, Manila, Republic of the
Philippines
Tel/Fax: 837-2945 Email: corly@dost.gov.ph
IATSS Forum Singaporean Secretariat
Secretary: Ms. Wendy Pang
c/o National Youth Council, 113 Somerset Road,
National Youth Center, Singapore 238165
Tel: 65-68399131 Fax: 65-67372025
http://www.nyc.gov.sg
Email: Wendy_Pang@pa.gov.sg
IATSS Forum Thai Secretariat
Secretary: Dr. Songphon Sukijbumrung
　cc: Ms. Rarai Thiangtham
c/o Department of Environmental Quality
Promotion, 49 Rama 6 Soi 30, Rama 6 Road,
Bangkok 10400, Thailand
Tel/Fax: 298-5646
Email: inter@deqp.go.th
IATSS Forum Vietnamese Secretariat
Secretary: Mr. Nguyen Van Trien
c/o Vietnam Asia-Pacific Economic Center,
176 Thai Ha Street, Trung Liet, Dong Da, Tel: 8574284 Fax: 8574316
Hanoi, Vietnam Email: iwep-htqt@fpt.vn, iwep@hn.vnn.vn