Community Leadership and Social Studies (CLASS) … · 2017 Application Form . A) Personal...

No. 605(A), San Yeik Nyein 6th Street, Kamayut Township, Yangon · Ph: 09 264680300/09 264680311/09 789086765 (9:00 AM to 5:00 PM) · Email: [email protected], website:www.thabyay.org/class

Community Leadership and Social Studies (CLASS) 2017 Application Form

A) Personal Information

FULL NAME

OTHER NAMES

DATE OF BIRTH DAY MONTH YEAR

ETHNICITY

MALE

FEMALE

RELIGION

N.R.C No

C) Residence Information

Street

City/Village

Division/State

Street

Division/State

CURRENT ADDRESS

Tsp.

City/Village Tsp.

Same as my permanent residence

PERMANENT ADDRESS

B) Contact Information

Mobile 1

Mobile 2

Email

Name

c/o

Emergency Contact

Relationship

Phone No.

This form should be completed in full and returned to Kant Kaw Education Centre in person or through KKEC partner organizations or emailed to [email protected]. Please answer all questions, otherwise your application will be disqualified. Application deadline: 28th Nov 2016, 5th May 2017 and 18th Aug 2017

D) Education

FORMAL EDUCATION - List your formal educational background, starting with the most recent (e.g: university, high school etc).

No. Course/Major Name of School Years Attended From/To

Certification (if applicable)

1.

2.

3.

4.

LANGUAGE EXAMS - Please indicate any language exams you have taken.

Testing Date (D/M/Y) Test Name (IELTS, TOEFL, Aptis, etc.) Test Score

1 of 3

Jan. Intake June. Intake Sept. Intake


F) Work/Volunteer BackgroundPlease list your work background starting with your most recent job. Include volunteer positions and community work. If you have more than four positions you are free to attach a separate document to describe any additional experience. TYPE OF POSITION (choose one): employment, internship, volunteer, other (please specify)

EMPLOYER:

1:JOB TITLE:

LOCATION:

From:

List the jobs you held, duties performed, skills used or learned, advancements, or promotions while you were with this organization:

REASON(S) FOR LEAVING (be specific):

To:

TYPE OF POSITION:

E) Language Proficency

Please indicate your proficency in all languages you know. List additional languages as needed.

Proficiency Key: 1=Elementary; 2=Pre-Intermediate; 3=Intermediate: 4=Advanced 5= Native (First language)

Language Writing ComprehensionReadingSpeaking

EMPLOYER:

REASON(S) FOR LEAVING (be specific):

List the jobs you held, duties performed, skills used or learned, advancements, or promotions while you were with this organization:

TYPE OF POSITION:

To:From:

JOB TITLE:

LOCATION:2:

Burmese

Ethnic

Other

2 of 3


Health (medicine/nursing/public health etc.)

please specify

Business Information Technolgy

Social Sciences -

Estimated start date

Social work

please specify

Media

Public Policy

Indicate which level you are intending for further study?

G) Academic Interest

Development studies

Education

Environment

Please indicate which subject you are interested in for further study after Kant Kaw?

BA MSc

H) EssaysOn a seperate piece of paper please answer the following questions. Please write a MINIMUM of 300 words per question. Your essays will help us evalauate your English and ensure that you are placed at an appropriate level. The essays should be written by the applicant only. Essay-1) Describe your background, including your family, childhood and educational experiences. Highlight one experience from your life and explain how it has influenced your development and future goals.

Essay-2) Why are you intereted in joining the CLASS program and how do you think Kant Kaw can help you to achieve your future goals?

Applicant's Signature Date

I certify that all of the information contained in my application and supporting documents are true, correct and honestly presented.

K) Document Check listPlease complete this application and return it to Kant Kaw Education Centre ([email protected]) or to a KKEC partner organization. Please submit ONLY the following documents:

Two completed essays

Two letter of recommendations using the KKEC Reference Form (one ACADEMIC and one PROFFESSIONAL/COMMUNITY-Based)

Completed CLASS application form

Copies of language test scores (if available)

I) Special Circumstances Use this space to explain any unusual expenses or special circumstances (health, physical, financial, social issues, etc) that we should consider when evaluating your application.

Other (please specify)_____________________________________________________

J) Accommodation If you are selected, what accommodation would you prefer to?

Stay with friends/relatives/monasteries in Yangon Stay in Kant Kaw student dormitory

MABScDiploma

Guiardian's Signature Date

Revised: Oct, 20163 of 3Guiardian's Name

Community Leadership and Social Studies (CLASS) … · 2017 Application Form . A) Personal...

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