AFS PRELIMINARY APPLICATION FORM SH24

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My preferred countries are: (Kindly refer: https://www.afsmas.org/program-list/)* This field is required.Negara-negara pilihan saya adalah: Sila rujuk di sini: https://www.afsmas.org/programlist/)

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Recent Photo* This field is required.Gambar Terbaru

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About You* This field is required.Tentang Anda

Full name (as in IC) – Nama Penuh (seperti dalam K/P)

Email Address - Alamat Emel

Identification Card(IC) Number – Nombor Kad Pengenalan

Home Phone Number – No. Telefon Rumah

Mobile Number – No. Telefon Bimbit

Gender - Jantina

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Birth date * This field is required.Tarikh Lahir

Date

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Home Address* This field is required.Alamat Rumah

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

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Do you have a disability?Adakah anda mengalami sebarang kecacatan fizikal?

Select one: - Pilih satu:

If Yes, please give details - (Jika Ya, sila nyatakan)

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School Info* This field is required.Maklumat Sekolah

Name of School - Nama Sekolah

Telephone Number - No. Telefon

Fax Number - No. Fax

I am in Form (kindly provide class name) - Saya di tingkatan (sila nyatakan nama kelas)

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School Address* This field is required.Alamat Sekolah

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

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Post held in school (if any)Jawatan disandang di sekolah (jika ada)

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Type of School (Please tick)* This field is required.Jenis Sekolah (Sila tandakan)

Residential school / Sekolah berasrama Penuh

International School / Sekolah Antarabangsa

Religious School / Sekolah Agama

Private School / Sekolah Swasta

Special Education School / Pendidikan Khas

Sekolah Menengah Kebangsaan

Sekolah Jenis Kebangsaan Cina

Sekolah Jenis Kebangsaan India

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Family StatusStatus Keluarga

What is your family structure? - Apakah status ibu bapa anda?

Information about the people with whom I live - Maklumat ibu/bapa yang saya tinggal bersama

If you live with your guardian(s), please indicate your relationship to your guardian(s) - Sila nyatakan hubungan anda dengan penjaga

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Father/Guardian* This field is required.Bapa/Penjaga

Father/Stepfather/GuardianName - Nama Bapa/Bapa Tiri/Penjaga

Status - Status

Mobile Number - No. Telefon Bimbit

Employer - Majikan

Office Number - No. Pejabat

Occupation - Pekerjaan

Email Address - Alamat Emel

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Mother/Guardian* This field is required.Ibu/Penjaga

Mother/Stepmother/Guardian Name- Nama Ibu/Ibu Tiri/Penjaga:

Status - Status

Mobile Number - No. Telefon Bimbit

Employer - Majikan

Office Number - No. Pejabat

Occupation - Pekerjaan

Email Address - Alamat Emel

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Sibling(s) details

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If your parents/guardian cannot be reached, please indicate someone in your community whom we can contact:* This field is required.Jika ibu bapa/penjaga tidak dapat dihubungi, sila nyatakan maklumat individu yang boleh dihubungi:

Full Name - Nama Penuh

Relationship - Hubungan

Email Address - Alamat Emel

Home Phone - No.Telephone Rumah

Mobile Number - No. Telefon Bimbit

Office Phone - No.Telefon Pejabat

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What are the primary languages spoken in your home?* This field is required.Apakah bahasa pertuturan anda di rumah?

Malay / Bahasa Melayu

English / Bahasa Inggeris

Mandarin / Bahasa Mandarin

Tamil / Bahasa Tamil

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If you speak other languages, Please indicateJika lain-lain, sila nyatakan:

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What other languages do you know? Please indicate your speaking ability in each language.Apakah bahasa pertuturan lain yang anda tahu? Sila nyatakan kemahiran bertutur anda

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Tell us about yourself: Introduce yourself, your personality, your relationship with your family and friends, your responsibilities at home/school, list your favourites, interests or hobbies etc.
Tell us about your expectation (before,during & after) the exchange program.
Tell us about your participation in school and community activities
Tell us about your goals/plans which are important to you; and why you think you should be chosen for the AFS Program?
You may write in English or Malay.

Perkenalkan diri anda, personaliti anda, hubungan anda dengan keluarga dan rakan-rakan, tanggungjawab di rumah / sekolah, senaraikan kegemaran, minat atau hobi anda.
Sila nyatakan harapan anda (sebelum, semasa & selepas) program pertukaran ini.
Senaraikan penyertaan anda di sekolah dan aktiviti-aktiviti kemasyarakatan
Sila nyatakan matlamat/perancangan yang penting kepada anda; dan mengapa anda layak dipilih untuk Program AFS?
Anda boleh menggunakan Bahasa Inggeris atau Bahasa Melayu

** Click 'Next' to write your statement / Sila terus ke laman sebelah untuk menulis kenyataan anda.

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** Your personal statement should be between 300-400 words ONLY* This field is required.Kenyataan diri anda haruslah di antara 300-400 patah perkataan SAHAJA

0/400

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How did you hear about AFS?* This field is required.Bagaimanakah anda tahu mengenai AFS?

Online/Atas Talian

School/Sekolah

Road Show/ Promosi Bergerak

Friends / Rakan

Newspaper / Surat Khabar

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Who is your referral? Siapakah yang memperkenalkan AFS Program kepada anda?

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Have any of your family members participated on an AFS program* This field is required.Adakah sesiapa dari ahli keluarga anda yang pernah menyertai program AFS?

YESNO

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If yes, please specify student’s name, host country and which year? Jika ya, sila nyatakan nama Pelajar, negara dan tahun penyertaan.

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Are you or any of your family members involved in AFS?* This field is required.Adakah anda atau sesiapa dari ahli keluarga anda terlibat di dalam AFS?

YESNO

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If yes, how? Jika ya, bagaimana?

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Do you have any volunteer experience? please list your volunteer activities (if any) Adakah anda mempunyai sebarang pengalaman dalam aktiviti sukarelawan Sila nyatakan disini sekiranya ada

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Are you willing to host an AFS participant?* This field is required.Adakah anda sudi menjadi keluarga angkat kepada peserta AFS?

YESNO

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Have you ever participated in any other exchange programs, traveled abroad or lived in another country?* This field is required.Adakah anda pernah menyertai mana-mana program pertukaran, melancong atau menetap di luar negara?

YESNO

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Yes. If yes, where and when, for what purpose? Please provide details; exchange program name, travel duration and country name. E.g.: UCC Summer Course in England in 2018 for two weeks (15 -29 November, 2018)Ya. Jika ya, dimana dan bila? Tujuan? Sila nyatakan nama program, tempoh dan nama negara. Contoh: UCC Summer Course di England pada tahun 2018 selama 2 minggu (15 -29 November 2018)

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I am applying for the following scholarship for which I am eligible for (This section is non-compulsory. You can move to the next section if you are not applying for scholarship)Saya layak untuk memohon biasiswa berikut

Scholarship Name - Nama Biasiswa (Pilih satu)

Family Annual Income (Select one) - Pendapatan tahunan keluarga (Pilih satu)

Number of dependents - Jumlah tanggungan

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I deserve a scholarship because… (Not more than 30 words) (This section is non-compulsory. You can move to the next section if you are not applying for scholarship)Saya layak untuk menerima biasiswa kerana… (tidak melebihi 30 perkataan)

0/30

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Please note that this scholarship application does not automatically guarantee you an AFS Scholarship. Your application will be reviewed by the AFS Selection Committee to determine your eligibility. However, you may still participate as a fee-paying candidate if you are unable to secure a scholarship.

We trust that your information in this application is valid, failing which your application will be disqualified.

Sila maklum bahawa permohonan biasiswa ini tidak menjamin biayaan Biasiswa AFS secara otomatik. Permohonan anda akan ditapis oleh Jawatankuasa Pemilihan AFS bagi menentukan calon yang layak. Bagaimanapun, anda masih boleh menyertai program ini sebagai calon berbayar, sekiranya anda tidak terpilih untuk biasiwsa ini.

Sekiranya didapati sebarang maklumat yang diberi tidak benar, permohonan anda akan dibatalkan.

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I HAVE DISCUSSED MY APPLICATION WITH MY FAMILY AND WISH TO APPLY FOR PARTICIPATION IN AN AFS PROGRAM

SAYA TELAH BERBINCANG DENGAN KELUARGA SAYA MENGENAI PERMOHONAN INI DAN INGIN MEMOHON UNTUK MENYERTAI PROGRAM AFS

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* This field is required.

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Applicant’s Signature* This field is required.Tandatangan Pemohon

Clear

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Parent/Guardian’s Signature* This field is required.Tandatangan Ibu/Bapa/Penjaga

Clear

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Payment slip (Screenshot or PDF)* This field is required.RM30 cash/online transfer to 'Yayasan AFS Antarabudaya Malaysia'. Maybank Account No. 512688102022.

Drag and drop files here

Select files to upload

Max. file size: 2.0MB

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Past 3 years’ school results (JPEG or PDF)* This field is required.

Drag and drop files here

Select files to upload

Max. file size: 2.0MB

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Photocopy of your IC (both side) * This field is required.(JPEG or PDF)

Drag and drop files here

Select files to upload

Max. file size: 2.0MB

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CHECKLIST* This field is required.SENARAI SEMAK

RM30 cash/online transfer to 'Yayasan AFS Antarabudaya Malaysia'. Maybank Account No. 512688102022. Attach the payment slip with application form. (Compulsory)

Your past 3 years’ school results (Compulsory)

A photocopy of your IC (both side) (Compulsory)

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IMPORTANT:
Please ensure your details are filled correctly. Once you clicked submit, you will not be able to make any changes.