ASEAN Youth Advisory Group of ASEAN Digital Literacy Programme

Part (I): Personal Details
Name *

First Name Last Name
Nationality *
Citizen of ASEAN countries only.
Date of Birth *

Month Day Year
Date
Age *
Gender *
Home Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Email *
example@example.com
Phone Number *

Area Code Phone Number
Do you consider yourself to have a dissability? *

No, I don't have a Disability. Yes, I have a Disability.

Please tell us your social media account: *

Where do you get the information about this programme? *

Social Media Friends Colleague Website Other

Part (II): Emergency Contact Details
These should be the details of the person we will contact in case of an emergency. Please note that they should either be your family members or guardian. Give two contact details.
Emergency Contact I
Name *

First Name Last Name
Relationship to you *
Contact Number *

Area Code Phone Number
Home Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Emergency Contact II
Name *

First Name Last Name
Relationship to you *
Contact Number *

Area Code Phone Number
Home Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Part (III): Motivational Essays
Do you live in a marginalise community? *

No Yes
Please answer all the questions below with a maximum of 500 words for each question.
Do you have experience in advocating or championing on digital security issue? *

No Yes
Do you have any experience in advocating or championing on digital literacy? *

No Yes
Why are you interested to apply as Youth Advisory Group? *

0/500
If you are chosen to join the programme, what project would you like to propose? *

0/500

Please rate yourself on the following traits: *

Part (V): Supporting Document
CV *

Cancel of
Letter of Interest

Cancel of
Disclosure Agreement *

I understand that all personal data provided in this submission is held strictly confidential will be used solely for ADLP programme purposes.
Should be Empty: