1 No (433), 5th Floor, Damaryone Street, Hlaing Township, Yangon (Ph: 09 421 050 957 / 09 425 306 808)

Intensive Program Application Form May 2014

This form should be completed in full and returned to Theik Khar Myanmar or emailed to tkmyanmar@gmail.com. Application deadline: April 5th, 2014. This information will be kept confidential.

A) Personal Information FULL NAME: OTHER NAMES: MALE FEMALE DATE OF BIRTH: DAY MONTH YEAR RELIGION (optional): ETHNICITY (optional):

B) Contact Information TELEPHONE EMAIL Landline: Primary Handset: Secondary:

2 No (433), 5th Floor, Damaryone Street, Hlaing Township, Yangon (Ph: 09 421 050 957 / 09 425 306 808)

C) Residence Information PERMANENT RESIDENCE (Parent's or Family's) Street City/Village Tsp. Division/State CURRENT ADDRESS Same as my permanent residence Street City/Village Tsp. Division/State

D) Education FORMAL EDUCATION - List your formal educational background, starting with the most recent (Ex: university, high school etc). No. Course/Major Name of School Dates Attended

From/To Certification (if

applicable) 1.

2.

3.

4.

3 No (433), 5th Floor, Damaryone Street, Hlaing Township, Yangon (Ph: 09 421 050 957 / 09 425 306 808)

TRAINING - List the trainings you have attended starting with the most recent. Attach additional pages if necessary No. Name of Training

Training

Organization

Year Duration Certificate Received

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

E) Language Proficiency Please indicate your proficiency in all the languages you know. List additional languages as needed Proficiency Key: 1=Basic Knowledge; 2=Proficient; 3=Fluent; 4=Native Language

Language Speaking Writing Reading Comprehension English

Burmese

4 No (433), 5th Floor, Damaryone Street, Hlaing Township, Yangon (Ph: 09 421 050 957 / 09 425 306 808)

F) Work/Volunteer Background Please 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 or your CV to describe any additional experience. TYPE OF POSITION (choose one): employment, internship, volunteer, other (please specify)

Job Title Employer Location From / To Type of Position

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)

Job Title Employer Location From / To Type of Position

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)

5 No (433), 5th Floor, Damaryone Street, Hlaing Township, Yangon (Ph: 09 421 050 957 / 09 425 306 808)

Job Title Employer Location From / To Type of

Position

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)

Job Title Employer Location From / To Type of Position

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)

G) Essays On a separate piece of paper please answer the following questions. Please write a MINIMUM of 300 words per question. Your essays will help us evaluate your English. The essays should be written by the applicant only.

6 No (433), 5th Floor, Damaryone Street, Hlaing Township, Yangon (Ph: 09 421 050 957 / 09 425 306 808)

1) Highlight ONE experience from your life and explain how it has influenced your development and future goals. Be creative. 2) Explain in your own words your understanding of the following quote from Gandhi: “It is the duty of every cultured man or woman to read sympathetically the scriptures of the world. If we are to respect others' religions as we would have them respect our own, a friendly study of the world's religions is a sacred duty.” 3) What do you consider is the main challenge that Myanmar is facing in order to develop as a modern nation?

H) Special Circumstances Use this space to explain any unusual expenses or special circumstances that we should consider when evaluating your application. For example (health problems, debts etc.)

I) Accommodation If you are selected, how will you arrange the accommodation? Stay with friends/relatives in Yangon Stay in the Theik Khar student hostel

J) Document Check list Please complete this application and return it to Theik Khar Myanmar by email (tkmyanmar@gmail.com) or in person at our school. Please submit ONLY the following documents:

1. Completed application form 2. Two letters of recommendation (one ACADEMIC and one PROFFESSIONAL/COMMUNITY base) 3. Completed essays

By filling in the information below I am indicating that all of the information contained in my application and supporting documents is true and honesty presented. Applicant’s Signature: Date: