APPLICATION FORM FOR YOUTH COMPETITION FOR DISASTER EDUCATION Selection for JENESYS 2.0 1.

GROUP INFORMATION Group Name Date of Establishment 2007 PALAPA Community Development Country Area of Operation City Group Contact Information Postal Address HME ITB, Labtek VIII (Basement), ITB, Ganeca 10 Bandung, Group Members* No 1 Name 2 3 4 Given Name Berlian Syahrial Family Name Agusta Ramadhan Middle Name Akbar Yon Degree Bachelor (Student) Bachelor (Student) Telephone E-mail palapahmeitb@yahoo.com

Indonesia Bandung

Brief Introduction of Group (vision, misson, and program outline) (150 words maximum)

Group Activity Report: Provide group activity report introducting actual programs/projects conducted in order to tackle the issues of concerning post-disaster reconstruction, disaster preparedness, engaged in children, handicapped & elderly care, in deal with LGBT issues, womens empowerment, or others (400 words maximum)

* The Group Leader putted first in the Group Name's Column

Group Motivation in Joining the Competition (200 words maximum)

What contribution that the group able to give after joining the trip to Japan? how do you aim to improve your programs using your experience in Japan? Please specify how your trip and learning there will directly contribute to your activities for the communities (Fellow students, neighborhood, recipients of your programs, etc) ? (750 words maximum)

group able to give after joining the trip to Japan? how do you aim to improve your programs using your experience in Japan? Please specify how your trip and learning there will directly contribute to your activities for the communities (Fellow students, neighborhood, recipients of your programs, etc) ? (750 words maximum)

2. PERSONAL INFORMATION 1 Name dd/mm/yyyy Date of Birth 8/8/1992 Current Contact Address Information Berlian Akbar Yon Agusta Age (as of Sex 21 Dec. 17, Nationality 2013 [v] M F

Indonesia

Kebon Bibit Utara 97/58 Bandung Wetan, Bandung 40116, Indonesia

akbarberlian@gmail.com

Mobile 6285795564911' Telephone Name of University or Graduate School

Email

Field of Study

Electrical Engineering 4th year/2010 Fair Fair Fair Poor Poor Poor

Information of Institut Teknologi Bandung Grade/Shool Year Your University Telephone or Graduate Address Labtek VIII, basement floor, Jalan Ganeca 10 Bandung, Jawa Barat Fax School Email Level of English Language Competency English Proficiency certificated score (if any) 560 Level of other Languages (Indonesia) Level of other Languages ( ) [v] Fluent [v] Fluent Fluent

Oversea Travel/Study Experience (list your major oversea trips/studies, if any)

One Semester exchange to Singapore (National University of Singapore) to improve my English and study about social sciences & arts (economic, business, world religion, storytelling); Two Months internship in Bangkok (Machine Vision Lab @ KMUTT (University)), One month internship in Bangkok (Solimac Automation (Company))

Briefly explain about yourself, including your After several attempt, several interview, and several decline, I managed myself to get my exchange background, personality, period. It was the best, I learnt how to speak English as an everyday language including it slangs, motivation in joining the

Last year, I decided to develop new personality which I called it No Hesitation personality. The goal is to make myself enjoy my life more than ever, by putting more impulse into my decisions, or simply put no hesitation to every choice in my life. The first mission was to be enrolled in one exchange program provided by my university.

Briefly explain about yourself, including your background, personality, motivation in joining the competition, as well as your volunteer / internship / professional experience (500 words maximum)

Last year, I decided to develop new personality which I called it No Hesitation personality. The goal is to make myself enjoy my life more than ever, by putting more impulse into my decisions, or simply put no hesitation to every choice in my life. The first mission was to be enrolled in one exchange program provided by my university. After several attempt, several interview, and several decline, I managed myself to get my exchange period. It was the best, I learnt how to speak English as an everyday language including it slangs, learnt social sciences (originally I study engineering), discussed new things with new people from around the globe. It was amazing. The side effect is that I need to postpone my study in the original university. I wont be able to graduate in the same time as my friends will do. I was anxious at first, but one says the first time always rough. Now Im glad I took the chance. It affects my personality to become a person who accepts more challenges and chances in the life. The biggest thing is now Im able to enjoy myself and my life more than ever. I really enjoy learn something bigger than I have learnt yesterday. As well as I enjoy make new friends and maintain old connections. This might be simple words that almost everyone knows how to says, but not everyone is able to do it as they might want to do it. There are some challenges ahead if one wants to do thing like this. For example, mastering how to chat with new friends by keeping the excitement and curiosity, what to talk, etc. Besides internal cause like I mentioned, one must know or able to understand what is going on in the world today, yesterday, or might happen tomorrow. Understand the pop culture that might be shared with other youth is a plus. I will not say it put no effort. One must catch up with what is going on in the world, means that one must receive information worldwide, while maintain local connection with local friends. Im proud to say that I did that, and I am the part of global-connected generation, while I still maintain to mingle with local friends. I would love to learn about the culture in Japan. I am interested in work culture of urban Japanese, as well as traditional culture of other Japanese. I would like to learn how the people work to solve their urban and rural problem. Everyone knows that Japanese are good at it. They put a lot of effort and integrity to what they do. I also would love to learn about the culture. I want to learn about Shinto and Zen Buddhism (Mahayana) which taught among the people in old Japanese. To learn about local religion and wisdom like this would increase my wisdom to solve social problem in my community, as well as improving my life afterwards.

Why do you think you should be selected? You can freely explain about your dreams, future, or anything (500 words maximum)

2. PERSONAL INFORMATION 2 Name Photo (taken within 3 months) Please write your name on the back of your photo. dd/mm/yyyy Date of Birth 4/1/1992 Current Contact Address Information Mobile Syahrial Ramadhan Age (as of Sex 21 Dec. 17, Nationality 2013 [v] M F

Indonesia

Kebon Bibit Barat 28, Bandung, Indonesia

syah_rama@ymail.com

8.566E+10 Telephone

Email

Name of University or Graduate School

Field of Study

Electrical Power Engineering 4th year/2010 Fair Fair Poor Poor

Information of Institut Teknologi Bandung Grade/Shool Year Your University Telephone or Graduate Address Labtek VIII, basement floor, Jalan Ganeca 10 Bandung, Jawa Barat Fax School Email Level of English Language Competency English Proficiency certificated score (if any) Level of other Languages ( Indonesia ) [v] Fluent [v] Fluent

Language Competency

English Proficiency certificated score (if any)

Level of other Languages ( Japanese Fluent ) Fair [v] Poor

Oversea Travel/Study Experience (list your major oversea trips/studies, if any)

I've never experienced any Oversea Travel/Study. Maybe this oppurtunity will become a great impact in my life.

My life pupose is to reach a certain goal. I make a goal for myself that i must serve for others. My first journey of helping people starting with Wae Rebo, Flores. It's a tribal village that live in the Briefly explain about center of jungle. Their life isn't easy, but they mostly smile in spite of rough environment that yourself, including your surrounding them. From them I learnt that happiness is come from within. The more you make background, personality, others happy the more happy you are. motivation in joining the Second , I learnt a lot from people in Cihurip, Garut. My experience living along with people in competition, as well as your there help a lot to build my empathy. In Garut, me and my friends helped people solve a community volunteer / internship / problem. There were group of people that dominate a shared facility. After took several discussions professional experience and personal interactions, we could create a new regulation that fair for everyone. That moment is (500 words maximum) a starting point in my life to learn what community development is. From my project in Wae Rebo, Flores I met Mrs. Tri Mumpuni and Mr. Iskandar Kuntoadji. They are CEO and founder of IBEKA. IBEKA is a famous NGO in my country that engaged in My country, Indonesia, have a lot of resouces and potential. Resources and potential must be used for the good of its own people.Reality in my country there are many poor people and the gap between rich and poor is too wide. People struggling to life because the price is elevating every year but their income is stagnant. The problem is they dont have capability and capital to cultivate resources that given. Developing my country is to empower people so they can give added value to Why do you think you their resources. By giving added value they can have more income to get. This method must be should be selected? You implemented in a community. If we use community-based development, we can have the benefit of can freely explain about development to every person. your dreams, future, or Enjoying my life is getting involve with new person everyday. By sharing you know each other anything (500 words problems and dreams. Understanding their problems is essentials if you want to help others. To maximum) solve a community problems is to listen every problems that everybody have and make a conclusion what is the main problems. The solutions must be fit with their condition. That why you must respect their culture and local wisdom. My dreams is developing a community potentials by respecting their local wisdom. If I selected, I'll very excited to learn others culture and their local wisdom. Because the more experience you have, making you ready to face a problems. If you want to solve a community problems, you must learn from other community. Experiencing isn't just

2. PERSONAL INFORMATION 3 Name Photo (taken within 3 months) Please write your name on the back of your photo. dd/mm/yyyy Date of Birth Age (as of Dec. 17, 2013 Sex Nationality M F

Current Contact Address Information Mobile Telephone Field of Study Grade/Shool Year Telephone Fax Email Email

Name of University or Graduate School Information of Your University or Graduate Address School

Level of English Language Competency English Proficiency certificated score (if any) Level of other Languages ( ) Level of other Languages ( )

Fluent Fluent Fluent

Fair Fair Fair

Poor Poor Poor

Oversea Travel/Study Experience (list your major oversea trips/studies, if any)

Briefly explain about yourself, including your background, personality, motivation in joining the competition, as well as your volunteer / internship / professional experience (500 words maximum)

Why do you think you should be selected? You can freely explain about your dreams, future, or anything (500 words maximum)

2. PERSONAL INFORMATION 4 Name Photo (taken within 3 months) Please write your name on the back of your photo. dd/mm/yyyy Date of Birth Age (as of Dec. 17, 2013 Sex Nationality M F

Current Contact Address Information Mobile Telephone Field of Study Grade/Shool Year Email

Name of University or Graduate School Information of Your University or Graduate School

Information of Your University or Graduate Address School

Telephone Fax Email Level of English Fluent Fluent Fluent Fair Fair Fair Poor Poor Poor

Language Competency

English Proficiency certificated score (if any)

Level of other Languages ( ) Level of other Languages ( )

Oversea Travel/Study Experience (list your major oversea trips/studies, if any)

Briefly explain about yourself, including your background, personality, motivation in joining the competition, as well as your volunteer / internship / professional experience (500 words maximum)

Why do you think you should be selected? You can freely explain about your dreams, future, or anything (500 words maximum)