Name of Alumni Member

12TH HITACHI YOUNG LEADERS INITIATIVE (12TH HYLI)

“THE ROAD AHEAD: ASEAN’S ROLE IN ASIA AND THE GLOBAL ECONOMY”

1 to 5 July 2013 Bangkok, Thailand

Thank you for your interest in HYLI! Each year we strive to bring together the region’s sharpest students to discuss the important issues facing Asia and the world, and provide an opportunity to meet with the prominent figures from government, business, academia and NGOs.

Interested? Please read the points below carefully and tick the boxes accordingly. Applicants who are unable to fulfill all of the criteria or perform the roles stated below are not eligible to participate in the programme.

Basic qualifying criteria Students interested in applying for the 12th HYLI must:

Be a full-time undergraduate or graduate at local universities, not exceeding the age of 28 at the time of the event (July 2013) Be Year 3 for students pursuing 3-year degree programmes and Year 3 and above for 4-year degree programmes at local universities Maintain a minimum CGPA / CAP / GPA of 3.0 out of 4 (or 3.5 out of 5) Be active in extra-curricular activities and / or community work Have a keen interest in and be familiar with regional and global affairs Have good written and spoken English, preferably with a flair for public speaking

Did you tick all the boxes? Congratulations, you are eligible for consideration to be a representative of your country at the 12th HYLI!

Important notes 1. The 12th Hitachi Young Leaders Initiative (HYLI) will be held from 1 to 5 July 2013 in Bangkok, Thailand. (Any travel dates required for those students from outside of Bangkok is NOT included in the program dates above.) 2. The final selection interviews are planned to be conducted in March 2013. Short-listed students must be available to attend their final interview. 3. Students selected to participate in the 12th HYLI will be required to submit a paper on their research and understanding of their designated sub-theme, prior to the initiative. 4. Students selected will be requested to present a performance during the 12th HYLI that is representative of their home country’s culture. 5. Students selected will act as ambassadors of their respective countries and will be required to respect the guidelines set out by the organiser and participate in all activities throughout the 12th HYLI. 6. The organiser will provide participants with economy airfare, hotel accommodation and a token allowance for the period of the initiative. 7. For information on past initiatives, please visit: http://www.hitachi.com/society/global/hyli/index.html 8. Please note that late submissions or incomplete application forms will not be considered.

Please submit the completed forms to Office of Student Affairs with details as followed: Recipient: International Relation Office Institut Teknologi Bandung Jl. Ganesha 17 Bandung 40132 Tel: +62 22 250 4282

-End of Note-

of 9 PARTICIPANT APPLICATION FORM

A. PERSONAL PARTICULARS

Attach Recent Colour Photo

Nationality

Country of Birth

Date of Birth

Age Sex Religion

Home Address

Home/Mobile Telephone Fax

Passport No./Identification No.

B. EDUCATIONAL INFORMATION

Please attach photocopies of results for all university level examinations. Institution Currently Attending

Faculty

Subjects Majored in

Current Year of Study (e.g. First year, Second year)

Grade Point Average (GPA / CGPA / CAP)

Educational Background

of 9 Schools/Institutions and Country Attended Highest Standard Passed Year Passed

Other Academic Qualifications

C. COMMAND OF ENGLISH LANGUAGE

TOEIC/TOEFL score (if applicable)

Written (Please state level of proficiency: excellent, good, fair)

Spoken (Please state level of proficiency: excellent, good, fair)

D. EXTRACURRICULAR ACTIVITIES

a. Societies/Clubs/Sports Type of Activity Description of Involvement (e.g. Position held, Period of Person In Charge level of participation, prizes and awards) Participation / Contact Details

of 9 b. Other Activities (e.g. Community and voluntary work, debates, essay/art competitions, scouts etc.)

c. Scholarships and Other Awards

d. Hobbies/Interests

E. Essays

Please answer the following questions (one or two paragraphs)::

□ The building of infrastructure – be it transportation, energy, information technology, or water – is one of the key ways countries can develop and grow. What infrastructure challenges face your country today? What is being done to address them? What would you do differently?

How do you think you can contribute to and benefit from this initiative?

______

The main theme for this programme is "The road ahead: ASEAN's role in Asia and the global economy." Which one of the following workshop sub-themes would interest you most and why?

 AEC 2015: What can ASEAN really expect and Asia's relevance in the global economy  Enhancing regional connectivity for a more competitive and resilient ASEAN

I hereby affirm that the information provided in this application form is true and accurate to the best of my knowledge.

of 9 ______

Signature Date

F. Reference

Please obtain the signature from one university official as a referee who supports your participation in the initiative. Please note that relatives and friends should not be used as referees and the organizer may contact the referee(s) for a testimony if necessary.

Occupation Company/Organization

Office/Mobile Number Email

Relationship to Applicant

I, ______, hereby affirm that the applicant of this application form fulfills the basic qualifying criteria to apply for the program and I recommend the applicant ’s participation in the initiative.

Basic qualifying criteria (Please check the criteria the applicant fulfills)

Be a full-time undergraduate or graduate at local universities, not exceeding the age of 28 at the time of the event (July 2013) Be Year 3 for students pursuing 3-year degree programmes and Year 3 and above for 4-year degree programmes at local universities Maintain a minimum CGPA / CAP / GPA of 3.0 out of 4 (or 3.5 out of 5) Be active in extra-curricular activities and / or community work

of 9 Have a keen interest in and be familiar with regional and global affairs Have good written and spoken English, preferably with a flair for public speaking

______Signature Date