YES! Programme Sign Up Form
Youth Empowered and Engaged To Serve

[Column]

[Data]

PART I - GENERAL INFORMATION

Primary Contact for Project (PLEASE NOTE: if chosen as Participant, the Primary contact will be notified initially but your TEAM must have at least 3 members and up to 7 members.)

Full name

First: Middle: Last:

Gender

Male Female

Address

E-mail

Telephone (fixed)

Telephone (mobile)

Date of birth

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College name

Group name

Group members

Other team members ( a Team should be minimum of 3 members and not more than 7 members)

No

Name

Telephone no

E-mail

Date of birth

Role

Responsibility

1

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2

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3

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4

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5

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6

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How did you hear about YES Programme?

PART II - SHORT ESSAY

Please type your complete responses to the question on the application below. You MUST answer every question in order to qualify.

1. Provide a detailed description of your idea. (50 Words or less)

2. What social issue OR community need does your idea hope to address OR economic opportunity that your idea will take advantage of?

3. What impact will your idea have on the community in which it is deployed? What do you hope to achieve?

4. What is unique and interesting about your idea?

By clicking the 'Submit' button, I certify that the information provided in this application is complete and accurate to the best of my knowledge.
Falsitification of any information will cause disqualification from the programme. This application becomes the sole property of AZAM
 and FARADALE MEDIA-M SDN BHD. I furthermore certify that I have read and hereby agree to the Official Rules of the YES Programme
and the terms of AZAM Terms of Use and Privacy Policy.