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AEON 1% CLUB FOUNDATION
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APPLICATION FORM
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Please fill in this form neatly in BLOCK Letters! Tick (☑)the box that applies.
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Fields in BOLD LETTERS are essential.
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Name in full (in fist language)GenderPhoto (4×3）
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□male □female
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LastFirst
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Name in full (in English)Nickname
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LastFirst
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Current Address
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Tel/Fax (Optional)Tel:Mobile:Fax:
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Social MediaFacebook:Instagram:
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Twitter:Others:
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E-mail(PC) Size of
T-Shirts		S ・ M ・ L ・ XL
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Date of birth / /AgeNationalityBlood Type
(Optional)
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Day /Month /Year
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Passport Number Expiry date / /
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Day /Month/Year
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Emergency Contact
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Full name:
Relationship with applicant:
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Tel:Mobile:
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School nameSchool
year
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Personal and Family circumstances (optional)
(Khó khăn của bản thân & gia đình (nếu có))		Future dream
(Mục tiêu nghề nghiệp/ ước mơ sau khi ra trường)
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Language skillsHobbies and interests (Optional)
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English score:TOEIC:_____________TOEFL:________________
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IELTS:_____________
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Other languages (optional) (please specify languages and your levels.)
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_______________________________________
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I, the undersigned, by signing this form, guarantee that I shall fully comply with the rules of this program, and the law and regulations of the host country during the course of the program.
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Signature
_________________________
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PART 2: ESSAY
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Topic:Những phẩm chất cần có của Nhà lãnh đạo tương lai
Essential Qualities of Future Leaders
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Your essay (can be written in EN/ VN):
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I, the undersigned, by signing this form, guarantee that I shall fully comply with the rules of this program, and the law and regulations of the host country during the course of the program.
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