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CONFIDENTIAL

Form 1

CURRICULUM VITAEPlease use a black or blue ball-point pen. Application documents and forms may also be downloaded and

completed by PC.

1. FULL NAME (as written in your passport)

PHOTO3.5cm4.5cm

Sur Name Given NameRIVAI ANWAR2. ADDRESS FOR CORRESPONDENCETELEPHONEBTN BATARA UGI BLOCK BO NUMBER 08 - +6285242092436

MAIL ADDRESS RIVAI.TAMBANG09@GMAIL.COM3. ()NAME AND ADDRESS OF PERSON TO BE NOTIFIEDIN CASE OF EMERGENCYTELEPHONE (Relationship to you)ASNAH ANWAR BTN BATARA UGI BLOCK BO NUMBER 08 - +6285242092436(SISTER)

4. DATE OF BIRTH 5. AGE 6. SEXDate Month Year 21 MALE FEMALE1 12 1990

7. MARITAL STATUS 8. NATIONALITY 9. RELIGION SINGLE MARRIED INDONESIAN ISLAM10. UNIVERSITY OF CURRENT ENROLLMENT

NAME OF INSTITUTION / CITY / COUNTRY MAJOR SUBJECTHASANNUDDIN UNIVERSITY SOUTH SULAWESI /

INDONESIA

MINE ENGINEER

11.LANGUAGE PROFICIENCYPlease, place an X at the level corresponding to your grade of language proficiency test or equivalent.

ENGLISH EXCELLENT GOODPOOR

NOT AT ALL

Score

JAPANESE

EXCELLENT

GOOD

POOR

NOT AT ALL

ScorePersonal information contained in application documents will be used for [1] all manner of contact from

application to program completion and return to home country, and [2] creating statistical documents that

summarize the results of the program.

mailto:RIVAI.TAMBANG09@GMAIL.COMmailto:RIVAI.TAMBANG09@GMAIL.COM

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CONFIDENTIALForm 2-1

Application Form

To: Yozo Kaneko,

President, Japan Overseas Cooperative Association

I wish to participate in the Youth-Exchange Project with Asia-Oceania and North

America (Kizuna (bond) Project) Long-term Invitation Program that your association is

implementing. I consent to the attached Terms and Conditions, and I hereby make my

application with the relevant documents attached.

SURNAME RIVAI GIVENNAME

ANWAR

NATIONALITY INDONESIAN COUNTRY INDONESIAMAIL ADDRESS (for notification of acceptance into the program)RIVAI.TAMBANG09@GMAIL.COM

1. Desired Training Course

Name of Course

(A,B,C,D)

Name of University, if C or D course

1st choice D HASANNUDDIN UNIVERSITY

2nd choice C HASANNUDDIN UNIVERSITY

3rd choice B

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CONFIDENTIALForm 2-2SURNAME RIVAI GIVEN

NAMEANWAR

2. What are you currently studying at your university or school?

I CURRENTLY STUDYING AT FACULTY OF ENGINEERING FOCUSING

ON MINING MATTERS AT HASANNUDDIN UNIVERSITY

3. What would you like to study about in Japan?

BASICLY ITS ABOUT THINGS THAT I WATCH ON DAILY JAPANESE

CARTOON, LIKE DORAEMON AND ETC, I REALLY INTEREST ONJAPANESE CULTURE, ABOUT THEIR DAILY LIFE, ABOUT HOW THEY

PURSUE THEIR DREAMS, HOW THEY SOLVE THIER PROBLEMS, HOW

THEY RELIEF FROM A DISASTER LIKE AN EARTHQUAKE, TSUNAMI

ETC.

4. What are your aspirations for participating in this program?

IS IT BASICLY THE LONG TERM GOAL, BECAUSE I HOPE THAT WHEN IT

COMES TO MY COUNTRY, WHEN THAT DISASTER HAPPEN I KNOWWHAT SHOULD I DO FOR MY COUNTRY AFTER I LEARN FROM

JAPANESS PEOPLE,ABOUT HOW TO FACING THAT KIND OF THINGS

5. Why would you be a good choice for this program?

BECAUSE I HAVE A MISSION, ALL THE DISASTER LIKE TSUNAMI,

EARTHQUAKE WHICH ALREADY HAPPENED IN JAPAN ALSO

HAPPENED IN MY COUNTRY, THE CASUAL VISUAL FOR THIS DISASTER

HAVE A HUGE NUMBER IN INDONESIA,I MEAN THE NUMBER OF

VICTIMS OF THIS DISASTER IS VERY HUGE. NOT ONLY ME BUT ALSO

THE WORLD KNOW, HOW JAPANESE GOVERNMENT AND ALSO THE

PEOPLE CAN RAISING UP AGAIN THEIR HOPES, AND THEY PROVE THAT

THEY CAN MOVE ON IN A VERY QUICK TIME. THE GOVERNMENT ALSO

QUICKLY RELIEF THE SPIRIT OF THEIR PEOPLE FROM THIS DISASTER .

AND MY MISSION IS TO LEARN THAT PARTICULAR THINGS TO BE ABLE

TO MAKE IT RETURN BACK TO MY COUNTRY

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CONFIDENTIALForm 2-3SURNAME RIVAI GIVEN

NAMEANWAR

9. How are you planning to relay the results of this program to the people in your

country after you finish participating in it?

I WILL INVOLVE MY SELF IN SEVERAL STUDENTSORGANIZATION IN

MY FACULTY, IN MY UNIVERSITY, GETTING CLOSER WITH

COMMUNITY AROUND ME, BECAUSE MY MAJOR STUDY FOUCSING ON

MINE AND SOME THINGS ABOUT GEOLOGIST, ILL USE MY

KNOWLEDGE AS A GEOLOGIST AS A TOLS TO SPREAD THE VALUES OF

THIS PROGRAM, START FROM MY FAMILY, FRIENDS AROUND ME. WITH

THIS EXPERIENCE ILL USE ON MY WORK PLACE LATER LIKE

REGARDING THE COMMUNITY SERVICES, ILL TELL THE PEOPLE, ILL

SPREAD THE VALUES OF EVERY LILTTLE THING THAT I GET FROM THIS

PROGRAM, START FROM MY LITTLE COMMUNITY , MAKE A

SOCIALSATION OF DISASTER RELIEF PROGRAM, AND FROM THAT

THEY WILL SPREAD IT AGAIN, NOT ONLY BY ME BUT BY THEM TO

OTHER AS WELL.

10. How would you like to utilize the experiences you had in Japan after this program

finishes?

LIKE WHAT I MENTION ABOVE, I WANT THIS BECAUSE I WANT TO

LEARN, I WANT TO GET EXPERIENCE, SO I CAN SPREAD IT OUT TO

MY FRIENDS, MY COMMUNITY AND TO THE DIFFERENT LEVEL IS TO

MY COUNTRYBUT I KNOW THAT I HAVE TO DO IT STEP BY STEP, ILL

START FROM MY FRIENDS, IS NOT THAT HARD TO ...HOW TO REACT

TO A DISASTER

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CONFIDENTIAL

Appendix

Terms and Conditions

Yozo Kaneko,

President, Japan Overseas Cooperative Association

If I am chosen as a participant in the program, I agree to devote myself to the program

while strictly adhering to the following.

1 I will observe the laws of Japan and the rules of the accepting institution, and

behave myself as a good participant.

2

I will faithfully follow the instructions and decisions of the implementation groupand the university.

3 I will redeem on my own responsibility any obligations incurred due to deliberate

or flagrant delinquency.

4 In the event that any of the following are deemed to apply and I am ordered to leave

the program, I will return to my home country at my own expense in accordance

with such order.

(1) It is impossible to continue the program for reasons of my deliberate or flagrant

delinquency or negligence

(2) I decide to quit the program at my own discretion

(3) I commit an act that disturbs the order of society

(4)

A false statement is discovered in the information filled out in an applicationdocument

5 I will promptly return to my country after the prescribed program ends, and I will

utilize the knowledge and experience I have gained to actively disseminate such

information to my local community.

End of document