Chương trình Youth Regional Affairs Dialogue (Đối thoại Thanh niên về các vấn đề khu vực)

SECTION I

PARTICIPANT INFORMATION

First Name:

Last Name:

Full Name as per Passport:

Nationality:

Gender (Please tick accordingly):

• Male
• Female

Date of birth (DD-MM-YYYY):

Age (as of 1 Jan 2022):

E-mail Address:

Local Mobile Number (with country code/area code):

Home Address:

Preferred Mailing Address:

Name of University:

Name of Department:

Curriculum Major:

Year of Study (as of Jan 2022):

Cumulative GPA (as of latest semester, please submit a pdf copy to organiser):

Co-curricular activities (please list the activities you are involved in, outside of school, if any)

Name of Activity #1:

Involvement level (eg. leadership, volunteering, production etc):

Name of Activity #2:

Involvement level (eg. leadership, volunteering, production etc):

Name of Activity #3:

Involvement level (eg. leadership, volunteering, production etc):

SECTION II

PERSONAL STATEMENT

Please answer all questions below.

1. Based on your past experiences, what contributions do you think you can make for the forum? Please provide your response in no more than 500 words.

2. In line with the topic of Social Cohesion, the following are 5 related themes that will be discussed in the dialogue. If your application is successful, you will be assigned to a group and be tasked to present on this theme. Please rank your preference of theme from 1-5 below, 1 being your top choice and 5 being your last.

*Do note that we may not be able to allocate you to your top choice due to a restriction in group numbers.

__ Culture & Identity

__ Income Inequality & Social Mobility

__ Growing Inter-Generational Divide

__ Media, Information & Technology

__ Healthcare & Well-Being

3. Based on your top choice of theme above, what are some of the pressing areas of social cohesion related to this theme in your country? Please provide your response in no more than 500 words.

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SECTION III

UNIVERSITY RECOMMENDATION

(All students must complete this section. You should approach YOUR UNIVERSITY DIRECTLY to seek recommendation.)

The University hereby recommend / does not recommend* _______________________________ (NAME OF STUDENT APPLICANT) to participate in the Youth Regional Affairs Dialogue 2022.

Name: _______________________________

Signature: _________________

Designation: __________________________

Date: _____________________

SECTION IV

Covid-19 Information

•           Students must take COVID-19 Pre-Departure Test (if required by Singapore at time of departure).

•           Students must be aware of the conditions of the host country Singapore and abide by local border measures and safety management requirements.

•           Students are required to follow the travel health control measures upon arrival in Singapore, more information can be found on the website: Travelling to Singapore (https://safetravel.ica.gov.sg/arriving/overview#social)

•           Students must factor in the cost of isolation / cost of medical treatment charges if they are tested positive for COVID-19 upon entry to Singapore or on return to home country which is to be borne by the students.

Covid-19 Vaccination Status:

□ Vaccinated                       □ Unvaccinated                      □ Medically exempted       

As part of Singapore’s Vaccination-Differentiated Safe Management Measures (VDS), you must be vaccinated to participate in certain activities in Singapore. You must be fully vaccinated with WHO EUL vaccines (click here for definition of fully vaccinated) at least two weeks before arrival in Singapore. If you are offered with a placement to join the programme, you may be required to provide a copy of your vaccination to us.

SECTION V

EMERGENCY CONTACT INFORMATION

Name:

Relationship:

Contact Number (with country code/area code):

E-mail Address:

SECTION VI

DECLARATION

I hereby declare that the details furnished above are true and correct to the best of my knowledge and belief. I undertake to inform you immediately of any changes. In case any of the above information is found to be false, untrue, misleading or misrepresented, I am aware that I may be held liable for them.

_______________________________________________________

Name and signature of student applicant / date

SECTION VII

PERSONAL DATA NOTICE & CONSENT

1. In compliance with the Personal Data Protection Act (“PDPA”), the Youth Regional Affairs Dialogue (YRAD) 2022 Organizing Committee at NTU seeks your consent to collect and use your personal data (ie. Name, contact numbers, mailing and email addresses) in order to maintain the following purposes:
   1. Register and review your application to the dialogue
   2. Register and contact you about your attendance at the dialogue;
   3. Carry out administrative and planning activities for the event;
   4. Plan and develop future activities and opportunities related to YRAD 2022;
   5. Facilitate your requirements in relation to the event;
   6. Allow the compilation and analysis of statistics relevant to the event;
   7. Produce publicity materials that will be shared among participants and to the public on YRAD’s social media sites and website;

(hereinafter referred to collectively as “Purposes”)

2. The YRAD 2022 Organizing Committee respects your privacy and assures that your personal data will be kept securely according to PDPA.

3. I hereby give my acknowledgement and consent to the YRAD 2022 Organizing Committee to use my personal data for the aforesaid Purposes. In the event that I wish to withhold or withdraw my consent to the YRAD 2022 Organizing Committee in respect of receiving telephone calls and/or SMS, I endeavour to provide sufficient notice to the YRAD 2022 Organizing Committee of such as soon as reasonably practicable.

4. I agree that my consent will remain in place until my withdrawal by officially notifying the YRAD 2022 Organizing Committee in writing at dialogue@ntu.edu.sg.

_______________________________________________________

Name and signature of student applicant / date