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[]
[]
[null,"Trilateral Youth Summit (TYS) 2019 Application Form\nDeadline: June 12, 2019, Wednesday 12 noon\nPlease send soft copy to tys@tcs-asia.org"]
[]
[null,"Name (Passport Name)","Last Name",null,"First Name",null,"Original Characters"]
[]
[]
[null,"Date of Birth","MM/DD/YY","Age (as of starting date of program)",null,"Nationality"]
[]
[]
[null,"Passport Number",null,"Passport Expiration Date",null,"Sex"]
[]
[null,"Current Address"]
[]
[null,"Contact Information","Email","Mobile","Emergency Contact Information","Relation with Applicant","Mobile"]
[]
[]
[null,"Education"]
[null,"Period (MM/YY)",null,"Name of Institution",null,"Major/Concentration"]
[null,"From","To"]
[]
[]
[]
[]
[]
[null,"Work experience and/or other activities"]
[null,"Period (MM/YY)",null,"Name of Organization/Company",null,"Position/Roles"]
[null,"From","To"]
[]
[]
[]
[]
[]
[null,"Language Proficiency"]
[null,"Test Type",null,"Level (if applicable)",null,"Test Score","Acquired Date (MM/YY)"]
[]
[]
[]
[]
[]
[null,"English Speaking\n(Excellent/Good/Poor)",null,"English Writing\n(Excellent/Good/Poor)",null,"English Reading\n(Excellent/Good/Poor)"]
[]
[null,"Hobbies/Interests"]
[]
[null,"Essay: Please answer the questions in English (250-300 words) for each question"]
[null,"1. Why do you wish to particpate in the Trialteral Youth Summit 2019? "]
[]
[null,"2. How do you think your qualities can contribute to the program?"]
[]
[]
[null,"Others (questions, concerns, additional information, etc.)"]
[]
[null,"Declaration\nI hereby certify that the statements written in this form are true and correct to my best knowledge. I understand that a false statement may disqualify me from participating."]
[null,"Agreement of the Handling of Personal Information\nI agree that my personal information in the Trilateral Youth Summit (TYS) 2019 Application Form and attached passport copy will be used in accordance with the following statements:\nAll information entered above will be used: 1) for selection purpose, 2) in case needed before and during the program, and 3) future networking for Trilateral Cooperation Secretariat’s education and youth programs. All information entered above will only be used for morally necessary purposes. \nPassport copy will be used to purchase flight tickets for selected applicants, and will be discarded responsibly by parties involved in the selection process for all applicants."]
[]
[null,"Date: MM/DD/YY"]
[]
[null,"Signature: _____________________________________________________________ "]

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[]
[null,"Health Condition"]
[null,"Blood Type",null,"A",null,"B",null,"AB",null,"O",null,"Unknown"]
[null,"Health Condition",null,"No chronic disease to report"]
[null,null,null,"Diagnosed with Chronic disease"]
[null,null,null,"Please specify:"]
[{"$nulls":4},"Chronic lung disease (asthma, chronic obstructive lung disease etc.)  "]
[{"$nulls":4},"Immunodeficiency state (T cell immunodeficiency etc.)　 "]
[{"$nulls":4},"Chronic heart disease (congenital heart disease, coronary artery disease etc.)"]
[{"$nulls":4},"Metabolic disease (diabetes)",null,null,null,"Renal dysfunction",null,null,"Obesity",null,"Myasthenia gravis"]
[{"$nulls":4},"Infectious diseases ",null,"(Please specify:                                                                                )"]
[{"$nulls":4},"Others","(Please specify:                                                                                )"]
[null,null,"Medical treatment cost related to the chronic disease is not covered by the programme insurance."]
[null,"Medicine",null,"Currently not taking perscribed medicines"]
[null,null,null,"Medicated on regular basis",null,null,"(Please specify:                                                                                )"]
[null,"Food Allergies\n(which may cause allergic reaction)",null,"None"]
[null,null,null,"Shrimp",null,"Crab",null,"Clam",null,"Fish",null,"Egg"]
[null,null,null,"Others","(Please specify:                                                                                )"]
[null,"Other Allergies and Restriction",null,"None"]
[null,null,null,"Dog",null,"Cat",null,"House dust"]
[null,null,null,"Others","(Please specify:                                                                                )"]
[null,"Food Restriction \n(for religion or custom reason only)",null,"None"]
[null,null,null,"Pork",null,"Beef",null,"Chicken",null,"Lamb"]
[null,null,null,"Shrimp",null,"Crab",null,"Clam",null,"Fish",null,"Egg"]
[null,null,null,"Others","(Please specify:                                                                                )"]
[null,null,"*Please be noted that the meals provided during the program cannot meet all the requests from the participants.         "]
[null,"Dietary \nRequirements",null,"None"]
[null,null,null,"Vegitarian",null,"Vegan",null,"Halal"]
[null,null,null,"Others","(Please specify:                                                                                )"]