EFC student exchange program
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STUDENT EXCHANGE PROGRAM
AFS STUDENT EXCHANGE
AFS STUDENT EXCHANGE PROGRAM (application form)
AFS Intercultural Programs, Student exchange program
Preliminary Application Form
Borang Permohonan
Recent Photo
Gambar Terbaru
All forms must be HANDWRITTEN clearly in black or blue ink pen and every question must be answered. Setiap borang hendaklah ditulis dengan jelas sama ada dalam dakwat hitam atau biru sahaja. Sila jawab semua soalan dengan lengkap.
CHECKLIST – SENARAI SEMAK
Check that you have filled in ALL the information on this form and includes: Semak semula SETIAP maklumat yang telah diisi dan sertakan perkara-perkara berikut:
A RM20 cheque/postal order/money order made payable to ‘Yayasan Antarabudaya Malaysia’ RM20 dalam bentuk cek/wang pos/kiriman wang dibuat atas nama ‘Yayasan Antarabudaya Malaysia’
Your past 2 years’ school results (Compulsory)
Keputusan peperiksaan yang terkini bagi 2 tahun yang lalu (Wajib)
A photocopy of your IC both sides
Satu salinan kad pengenalan (kedua-dua belah)
A recent passport photograph of yourself
Gambar berukuran passport yang terbaru.
PERSONAL INFORMATION – MAKLUMAT PERIBADI
Name (as in IC) (Mr/Ms) – Nama (seperti di dalam
IC Number – Nombor Kad Pengenalan
K/P) Encik/Cik
Gender – Jantina
House Phone Number – Nombor Telefon Rumah
Postal Address – Alamat Rumah
Mobile Phone Number – Nombor Telefon Bimbit
Email address – Alamat Email
OTHER INFORMATION – MAKLUMAT LAIN
How did you hear about AFS? – Bagaimanakah anda mengetahui mengenai AFS? Online
School
Road Show
Internet
Sekolah
Promosi Bergerak
Friends
Newspaper
Others
Kawan
Suratkhabar
Lain-lain
My preferred countries are (kindly refer to the list of programs offered): Negara-negara pilihan saya (Sila rujuk senarai program yang ditawarkan): 1.
2.
3.
(We cannot guarantee your first choice but we will do our best!) – (Kami tidak memberi sebarang jaminan anda akan mendapat pilihan pertama anda.)
About your interest in the AFS Program
Sila Pilih Daripada Program-program Berikut
Departing in:
I am interested in
Saya berminat untuk mengikuti :
Bulan Berlepas:
Year Program (11–12 months)
Intensive Program (6–8 weeks)
Dec/Jan/Feb/March
Program Setahun (11-12 bulan)
Program Intensif (6–8 minggu)
Dis/Jan/Feb/Mac
Semester Program (6 months)
Very Short Program (2 – 4 weeks)
Jun/July/Aug/Sept
Program Semester (6 bulan)
Program Pendek (2 – 4 minggu)
Jun/Julai/Ogos/Sept
www.afsmas.org
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SCHOOL INFORMATION – MAKLUMAT SEKOLAH
Name of School – Nama Sekolah
School Address – Alamat Sekolah
Telephone Number – Nombor Telefon
Fax Number – Nombor Fax
I am in Form (Kindly provide class name) – Saya di Tingkatan (SIla catitkan nama kelas) Post held in school (if any)- Jawatan disandang di sekolah
INFORMATON ABOUT PARENTS / GUARDIAN (S) MAKLUMAT IBUBAPA / PENJAGA Father / Stepfather / Guardian – Bapa / Bapa Tiri / Penjaga
Employer – Majikan
Occupation – Pekerjaan
Office Number – Nombor Pejabat
Mobile Number – Nombor Telefon Bimbit
Email Adress – Alamat Email
Mother / Stepmother / Guardian – Ibu / Ibu Tiri / Penjaga
Employer – Majikan
Occupation – Pekerjaan
Office Number – Nombor Pejabat
Mobile Number – Nombor Telefon Bimbit
Email Adress – Alamat Email
EMERGENCY CONTACT – MAKLUMAT KECEMASAN
If your parents / guardian cannot be reached, please indicate someone else in your community whom we can contact:
Jika ibubapa/penjaga anda tidak dapat dihubungi, sila nyatakan maklumat orang (selain keluarga) yang boleh dihubungi:
Full Name – Nama Penuh
Office Phone – Telefon Pejabat
Relationship – Hubungan
House Phone – Telefon Rumah
HOSTING – PENEMPATAN PELAJAR ASING
Have any of your family members participated on an AFS program? Adakah sesiapa daripada ahli keluarga anda pernah menyertai program AFS?
No
Yes, who, where and which year
Tidak
Ya, Jika ya, sila sertakan nama, negara serta tahun penyertaan
Are you or any of your family members involved in AFS?
Adakah anda atau sesiapa daripada ahli-ahli keluarga anda terlibat dalam AFS?
No
Yes, if yes, how?
Tidak
Ya, Jika ya, bagaimana?
www.afsmas.org
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Mobile Number – Telefon Bimbit
PERSONAL STATEMENT – PENGENALAN DIRI
Do you know of anyone (family, friends, relatives, etc) who would like the opportunity to host an AFS student? With their permission, please provide contact details. Your support of hosting would be appreciated. Adakah anda mengetahui sesiapa di kalangan (keluarga, rakan-rakan, saudara-mara , dan lain-lain) yang ingin menjadi keluarga angkat kepada pelajar AFS? Sila sertakan seperti berikut. Sokongan anda amat dihargai:
Name – Nama
Contact Number – Nombor Telefon
Email Adress – Alamat Email
• Describe yourself and your personality and what is important to you Huraikan diri dan personaliti anda dan apa yang penting untuk anda
• Detail your participation in school and community activities Perincikan penyertaan anda di sekolah dan aktiviti-aktiviti masyarakat
• What do you hope to gain from the AFS program
Apakah harapan anda yang ingin diperolehi daripada program AFS?
(Your entire personal statement should be between 80 – 100 words ONLY) (Kenyataan diri anda sepatutnya di antara 80 – 100 kata-kata SAHAJA)
www.afsmas.org
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SCHOLARSHIP APPLICATION – PERMOHONAN BIASISWA
For the list of scholarships available, please refer to the list of scholarship (in the insert) Untuk senarai biasiswa-biasiswa yang boleh dipohon, sila rujuk senarai biasiswa yang terdapat
if you wish to apply for an AFS Scholarship, please complete the scholarship section below. Jika anda ingin memohon untuk biasiswa AFS, sila lengkapkan bahagian biasiswa di bawah.
Please note that, application for scholarship does not automatically guarantee you an AFS Scholarship. Your application will be reviewed by the AFS Scholarship Selection Committee to determine whether you are eligible to receive our scholarship. However, you may still participate as a fee paying candidate if you fail to receive one. Should any information disclosed is found untrue, your application will be disqualified. Adalah dimaklumkan bahawa permohonan ini tidak secara automatik melayakkan anda untuk sebarang biasiswa AFS. Permohonan anda akan dikaji semula oleh Jawatan Kuasa Pemilihan Biasiswa AFS untuk menentukan sama ada anda layak menerima biasiswa tersebut. Bagaimanapun, anda masih boleh menyertai program berbayar AFS sekiranya gagal mendapatkan sebarang biasiswa. Sekiranya didapati sebarang maklumat yang diberi tidak benar, permohonan anda akan terbatal.
I am applying for the following scholarship(s) for which I am eligible for: Saya layak untuk memohon biasiswa berikut:
Name of scholarship(s):
Nama biasiswa:
Family Income Level
Income level per year (Please tick)
Additional Information
Tahap Pendapatan Keluarga
Maklumat Tambahan
Tahap Pendapatan Tahunan (Tolong tandakan)
Single income family
Up to RM 30,000
Tanggungan Tunggal
Sehingga RM 30,000
One dependent
RM 31,000 – RM 50,000
Satu tanggungan
Two dependents
RM 51,000 – RM 70,000
Dua tanggungan
Three dependents
RM 71,000 – RM 80,000
Tiga tanggungan
RM 81,000 and above
Four or more dependents
RM 81,000 dan lebih
Empat atau lebih tanggungan
(In not more than 30 words)
I deserve a scholarship because…
(tidak melebih 30 perkataan)
Saya berhak untuk menerima biasiswa ini kerana..
DECLARATION – AKU JANJI
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
Signature of applicant, Date – Tandatangan Pemohon, Tarikh
www.afsmas.org
Signature of parent/guardian, Date – Tandatangan Ibu/Bapa/Penjaga, Tarikh
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YEAR PROGRAM
PROGRAM SETAHUN
Destination
Depart
Return
Fee (RM)
Form (YR 2013)
Destinasi
Berlepas
Ketibaan
Yuran (RM)
Tingkatan (Tahun 2013)
Argentina
Feb ‘14
Jan ‘15
25,000
5
Costa Rica
Feb ‘14
Jan ‘15
24,000
5
Germany
Feb ‘14
Jan ‘15
26,000
5
Japan
Mar ‘14
Feb ‘15
24,000
5
New Zealand
Feb ‘14
Jan ‘15
28,000
5
Switzerland
Feb ‘14
Jan ‘15
26,000
5
Belgium Flanders
Aug ‘14
Jul ‘15
24,000
5
Canada
Aug ‘14
Jul ‘15
28,000
5
France
Sep ‘14
Jul ‘15
25,000
5
Austria
Aug 14
Jul ‘15
26,000
5
SEMESTER PROGRAM
PROGRAM SEMESTER
Destination
Depart
Return
Fee (RM)
Form (YR 2013)
Destinasi
Berlepas
Ketibaan
Yuran (RM)
Tingkatan (Tahun 2013)
France
Jan ‘14
Jul ‘14
19,000
5
Austria
Jan ‘14
Jul ‘14
19,000
5
USA (Youth Exchange & Study)
Jan ‘14
Jul ‘14
Scholarship
5
USA (British Petroleum Program)
Jan ‘14
Jul ’14
Scholarship
5
Japan (KIZUNA)
Aug ‘14
Feb’15
Scholarship
5
scholarship
5
INTENSIVE PROGRAM (6-8 WEEKS)
PROGRAM INTENSIF (6-8 MINGGU)
Destination
Depart
Return
Fee (RM)
Form (YR 2013)
Destinasi
Berlepas
Ketibaan
Yuran (RM)
Tingkatan (Tahun 2013)
China
Dec ‘13
Feb ‘14
11,000
3, 4 & 5
Finland
Jul ‘14
Aug ‘14
12,000
3&5
France * Minimum 2 Years of studying French Language
Dec ‘13
Feb ‘14
13,000
3, 4 & 5
Italy
Dec ‘13
Feb ‘14
13,000
3, 4 & 5
Japan (Language Studies)
Dec ‘13
Jan ‘14
14,000
3, 4 & 5
Turkey
Dec ‘13
Feb ‘14
11,000
3, 4 & 5
VERY SHORT PROGRAM (2– 4 WEEKS)
PROGRAM JANGKA PENDEK (2-4 MINGGU)
Destination
Depart
Return
Fee (RM)
Form (YR 2013)
Destinasi
Berlepas
Ketibaan
Yuran (RM)
Tingkatan (Tahun 2013)
Dec ‘13
Dec ‘13
Scholarship
3, 4 & 5
Japan (KIZUNA)
PROGRAMS OFFERED – PROGRAM YANG DITAWARKAN
Denmark
Jan’14
Feb’14
13,000
3, 4 & 5
Germany (Green Academy)
Jan’14
Feb’14
13,000
3, 4 & 5
Please note that AFS reserves the right to change the program fee and details without prior notice AFS Yayasan Antarabudaya Malaysia berhak menukar jumlah yuran serta syarat dan terma tanpa sebarang notis AFS also reserves the right not to proceed with the program if it is deemed not viable or is cancelled by the host country AFS juga berhak untuk tidak meneruskan program jika didapati program tersebut tidak sesuai ataupun dibatalkan oleh negara yang menawarkan program tersebut.
The RM 20 application fee is not refundable
Yuran permohonan sebanyak RM 20.00 tidak akan dikembalikan
Incomplete applications will not be accepted
Permohonan yang tidak lengkap tidak akan diterima
Short listed candidates will be called for an interview with the Education State Dept in May/June 2013 Pelajar yang disenarai-pendekkan akan dipanggil untuk menghadiri temuduga di Jabatan Pelajaran Negeri masing-masing pada bulan Mei/Jun 2013.
SCHOLARSHIPS – MAKLUMAT BIASISWA
As part of AFS Malaysia‘s commitment to help your dream come true, we offer various scholarships that you could be eligible for!
Sebahagian dari komitmen kami di AFS Yayasan Antarabudaya Malaysia adalah untuk membantu menjadikan impian anda kenyataan dengan menawarkan pelbagai biasiswa.
Scholarships available:
Biasiswa-Biasiswa yang ditawarkan:
Yayasan Antarabudaya Malaysia Scholarship
Biasiswa Yayasan Antarabudaya Malaysia
Partial scholarship for Year Program ONLY. A scholarship provided by the Yayasan Antarabudaya Malaysia Foundation Trust Fund. This prestigious scholarship requires students to exhibit academic excellence, community service and leadership, and be nominated by their high school. Priority will be given to those applying for non-English speaking countries.
Biasiswa yang disediakan oleh Yayasan Antarabudaya Malaysia adalah biasiswa separa bagi Program Setahun yang ditawarkan kepada semua pelajarpelajar seluruh Malaysia. Biasiswa berprestij ini memerlukan pelajar mempamerkan kecemerlangan dari segi akademik, khidmat komuniti dan kepimpinan semasa di sekolah. Keutamaan akan diberikan kepada yang memohon untuk ke negara-negara asing.
K-L YES Scholarship (Kennedy-Lugar Youth Exchange & Study)
Biasiswa K-L YES
In line with the YES Program, 45 full merit scholarships are available to outstanding students for a six months study abroad in USA. Fully sponsored by US State Department, applicants must be 15 – 17 years old, obtain consistently strong grades and no failing grades and show a keen interest in
USA and in learning the American ways.
Sejajar dengan program K-L YES, 45 biasiswa merit penuh ditawarkan kepada pelajar cemerlang untuk 6 bulan pembelajaran di Amerika Syarikat. Ditaja sepenuhnya oleh US State Department, pemohon-pemohon mestilah berumur diantara 15-17 tahun, mendapat gred akademik yang cemerlang dan tidak mempunyai gred gagal serta menunjukkan minat mendalam terhadap Amerika Syarikat serta budaya di sana.
BP Scholarship (British Petroleum Scholarship)
Biasiswa BP
Open to academically outstanding Malaysian students (especially strong grades in Mathematics and Science subjects) for a semester program. Priority will be given to students who have no financial means of participating unless granted a scholarship.
Terbuka kepada pelajar cemerlang – biasiswa merit penuh ditawarkan kepada pelajar cemerlang untuk 6 bulan pembelajaran di Amerika Syarikat. Ditaja sepenuhnya oleh British Petroleum, pemohon-pemohon mestilah berumur diantara 15-17 tahun, mendapat gred akademik yang cemerlang dan tidak mempunyai gred gagal serta menunjukkan minat mendalam terhadap Amerika Syarikat serta budaya di sana.Keistimewaan diberikan kepada pelajar yang daripada keluarga yang kurang berkemampuan
KIZUNA Scholarship
Biasiswa KIZUNA
Initiated by former Japanese Government, the KIZUNA Scholarship is open for students from the age of 15 – 18 years old who would like to go on
• Semester Program (must be in Form 5) – 2 scholarships OR • 2-weeks exchange program to Japan (Form 3, 4 and 5) – 28 scholarships This project is a part of Japanese reconstruction plans and aims at promoting global understanding of Japan’s revival efforts in response to the Great East Japan Earthquake. Participants on KIZUNA Very Short Program are required to participate in a
4-day program organized by Japan International Cooperation Center (JICE) in Tohoku disaster area (except for the restricted area and deliberate evacuation area) during their experience and the Semester Program participants are required to visit 3 times, 4 days each time.
