NOT FOR SALE

Please carefully read the Application Guidance before completing this form.
Type or handwrite clearly, and do not exceed the space provided for each section.
Note: Please type or handwrite clearly and tick appropriate boxes that should appear as☑.
Deadline is
August 20, 2025 !! (FOR OFFICE USE ONLY: Registration Number )

The 26th Duskin Leadership Training in Japan

A Program for Persons with Disabilities in Asia and the Pacific (2026)

1. Name
First (given) name(s) Middle name Second (family) name

In your native language: ‫زاہد‬ / ‫اقبال‬ /‫یوسف‬

In English alphabet: ZAHID / IQBAL / YOUSAF
2. Sex 3. Date of Birth * Applicants must be between 18 and 35 years old (inclusive).

✓ Male Female Year Month Day

☐ Unspecified 1997 / 12 / 18 Age : 27 (as of August 20, 2025)

4. Contact details
✓ Home ☐ Office ☐ Other (please specify : )

Postal address: CHAK NO 281 G.B JARANWALA FAISALABAD PUNJAB PAKISTAN

Country: PAKISTAN

Telephone: N/A Fax : N/A

Mobile phone : +923422499150 Email: zahidgk172@[Link]

5. Type of disability

☐ Physical ☐ Visual ☐ Hearing ☐ Intellectual ☐ Mental

☐ Other (please specify :
6. Nationality
1. PAKISTAN Attach your photo here

A photo must show your face and entire body. It must

have been taken in the past 3 months.
7. Native language (mother tongue)
1. URDU If you are applying by post, please write your full name on the
2. PUNJABI back of the photo.
3. ENGLISH
If you are applying by email, please send your photo as a
8. Religion separate attachment.
1. MUSLIM

9. Marital status

✓ Single ☐ Married
 Note: Please type or handwrite clearly and tick appropriate boxes that should appear as ☑.

10. What do you do?

✓ I am a student ☐ I work ☐ Other (please specify : )

If you are a student, please provide details of your institution:

Name of your School/College/Institution :

Govt College, University of Faisalabad. Punjab, Pakistan.
Address :

Your school Year/Grade:

Govt College University, Faisalabad./ 2018- 2022 / 60%

Your major :
Bachelor of Physics.

When do you expect to graduate?

My degree was completed in. SEP 2022

If you have employment or any other kinds of work, please provide details below.

☐ NGO ☐ Public administration/government

Your organization type: ☐ Private firm/institution ☐ Other type of institution
☐ Self-employed ☐ Family-run business
☐ Freelance ☐ Other (details : )

Your status: ☐ Paid staff ☐ Unpaid staff/Volunteer

☐ Intern/Trainee ☐ Other (details : )
THE AIMS SCHOOL SYSTEM TANDLIANWALA
Name of Your Employer
(Organization/Company):

TANDLIANWALA FAISALABAD PUMJAB PAKISTAN

Address :

Telephone :
+923477765560

Fax :

Website:

Email:
Provide education.
Describe specialty of your
organization and its main business :

TEACHER
Describe your job details
including your present title :
 Note: Please type or handwrite clearly and tick appropriate boxes that should appear as ☑.

11. Do you belong to any organization of/for persons with disabilities?

□ No, I don’t belong to any organization. □ Yes, I belong to the following organization.
Name of the organization :
Address :
Telephone:
Website:
Email:

Its purpose and activities:

How are you affiliated with this ☐ Staff ☐ Member ☐ Volunteer

organization? (tick an appropriate box) ☐ Service user ☐ Other

Describe your involvement:

12. Education

[Link]/ School
Give the name of the institution from which you graduated, your degree/major and completion
date. Please write up to 3 most recent.
Please exclude information that you have already mentioned in Section 10.
Attended From Attended To Degree, Certificate
Name City/Country
(Month/Year) (Month/Year) or Diploma
Govt High School Faisalabad/ Pakistan. MAY,2015 JULY,2015 O level certificate.
282 GB
Govt COLLEGE Faisalabad/ Pakistan. AUG ,2015 SEP,2018 A level certificate.
JARANWALA
Govt College Faisalabad/ Pakistan. SEP, 2018 SEP, 2022 Bachelor certificate.
University Faisalabad
[Link]/Seminar
List training courses and seminars etc. that you have attended and qualifications that you hold.
Please write up to 3 important trainings for you.
From To
Name City/Country Certificates obtained
(Month/Year) (Month/Year)
AL-FALAH ACADEMY Faisalabad/ Pakistan. JAN,2023 JUNE, 2023 Computer Certificate.

13. Work Experience

Please write up to 3 most recent.

Please exclude information that you have already mentioned in Section 10.
Name of employer/ Description of From To Title, duties and
organization organization (Month/Year) (Month/Year) responsibilities
AIMS SCHOOL EDUCATION OCTO,2022 JUNE,2024 teacher/Teaching.
 Note: Please type or handwrite clearly and tick appropriate boxes that should appear as ☑.

14. Reason for applying : Why do you want to participate in this training
program?
My name is Zahid Iqbal Yousaf, and I am a young person with visual impairment from Faisalabad,
Pakistan. I am very interested in joining the Duskin Foundation program because I want to become
a leader in my community and support other persons with disabilities.

I have read that this program gives young persons with disabilities from Asia and the Pacific the
chance to learn about welfare policies and services in Japan. I am very excited about this. I want to
see how Japan supports people with disabilities and learn from their system. This will help me bring
new ideas and skills back to my country, so I can help others like me.

Even though I have low vision, I can travel, communicate well, and move independently. I enjoy
exploring new cultures and places. I am always ready to learn new things. This program is a great
opportunity for me to grow, connect with others, and prepare for future leadership.

I hope you will give me a chance to be a part of this valuable program. I am fully ready to learn,
experience, and share what I gain from Japan with my community.

Thank you very much.

15. Your training plan : What do you want to learn in Japan?

with disabilities get support in their daily lives. I am interested in the welfare system, assistive
technologies, and how accessible buildings, transport, and education are made for everyone. I also
want to learn how Japanese people with disabilities become independent and active in society. This
will help me understand new ideas that I can use in my own country. I also want to learn about
Japanese culture, values, and how people work together to build an inclusive society.

16. Your future plan : What will you do after training?

After the training in Japan, I want to come back to my country, Pakistan, and share everything I
learn with other people with disabilities. I will guide them about new ideas, tools, and ways to live a
better and more independent life. I also want to work with local organizations, schools, and
communities to raise awareness about disability rights and accessibility. My goal is to help build a
more inclusive society in Pakistan where people with disabilities get equal chances to grow and
succeed. This training will give me the knowledge and confidence to support others and become a
voice for change in my country.
 Note: Please type or handwrite clearly and tick appropriate boxes that should appear as ☑.

17. Your disability

What is the name of your disability? vision with nystagmus

Please describe details about your disability including medical records.

I have a high refractive error with an eye power of +14, which significantly affects my ability
to see clearly. In addition, I have nystagmus, a condition that causes involuntary and
continuous eye movement, making it harder to focus on objects or text. Due to this
condition, I also experience optic nerve sensitivity, eye strain, and discomfort in bright light
or glare.
According to my eye examination reports, my vision is measured at 6/38, which qualifies as
a visual impairment. I have been diagnosed by an eye specialist, and my medical records
can be provided upon request. Despite this challenge, I actively manage my education,
daily tasks, and teaching responsibilities using assistive tools and accessible technology.

Do you require any assistance in your daily life? □YES □NO

If YES, please tick all appropriate boxes below :

- Aids: □Electric Wheelchair □Manual Wheelchair □Crutches □Guide dog

□White cane □Other (please specify : )

- Personal Assistant : □Full-time □Part-time

→ □Mobility □Transferring □Eating □Cooking □Cleaning □Clothing □Toileting
□Bathing □Other (please specify : )

Give any additional information which would help us to understand your disability and condition:
18. Do you have a dietary, medical or any other restriction in your daily life due to your
religion or health condition?
I do not have any de-steroid medications or religious restrictions that affect my daily life. However,
due to my visual impairment, I sometimes need accessible formats or visual support, especially in
reading small text or navigating unfamiliar environments. Despite this, I live independently,
participate actively in educational and social activities, and manage my daily tasks without major
limitations
 Note: Please type or handwrite clearly and tick appropriate boxes that should appear as ☑.

19. Describe your personal history.

My name is Zahid Iqbal Yousaf, and I have been an active and confident student since primary
school. I often led my class, helped other students, and was selected for leadership roles and
school-level scholarships. I gave speeches and took part in many activities that improved my
communication skills. Even with visual impairment, I kept working hard. During O Levels, I faced
many challenges but stayed involved in sports and co-curricular programs. After completing ICS
from Jaranwala, I improved my English and built better communication through interaction with
teachers. I later completed a computer diploma and then moved to Faisalabad for a Bachelor's in
Physics. There, I promoted tourism, explored Pakistan’s cultures, and worked with the blind
community by giving speeches and teaching both low vision and fully blind students. I also
developed strong computer skills like using MS Word, Excel, creating educational materials, and
building websites with AI tools. Alongside studies, I enjoy gym, football, reading, learning about
technology, disability rights, and community work

20. What are your hobbies and interests?

Gym, Football, Reading, Traveling, Exploring Cultures, Learning about Disability Rights, Studying
Assistive Technologies, Volunteering, Social Networking, Leadership Learning, Community
Support, Inclusive System Awareness

21. Have you traveled abroad before? Give details of any travel experience abroad
(e.g., study, training and holidays), including its destination, duration and purpose.
NO

22. How did you learn about this program and where did you get this application form?
*Please check the appropriate boxes below and fill in the details in the space provided
□ Friend/former trainee □ Organization (specify)
□ JSRPD website □ SMS (Instagram, Facebook, etc.)
－ Please specify details below. －
 Note: Please type or handwrite clearly and tick appropriate boxes that should appear as ☑.

23. Your language skills – Circle a number that indicates your level on each scale bar.

ENGLISH

Speaking : None Basic communication Everyday conversation Business level Native level

1 2 3 4 5

Listening: None Basic communication Everyday conversation Business level Native level

1 2 3 4 5

Reading : None Some words Simple sentences Short stories Newspapers

1 2 3 4 5

Writing : None Some words Simple sentences Short essays Business reports

1 2 3 4 5

JAPANESE

Speaking : None Greetings Basic communication Everyday conversation Business level

1 2 3 4 5

Listening: None Greetings Basic communication Everyday conversation Business level

1 2 3 4 5

Reading : None Some letters Simple sentences Short stories Newspapers

1 2 3 4 5

Writing : None Some letters Simple sentences Short essays Business reports

1 2 3 4 5

Do you use or understand any of the followings? Please tick all appropriate boxes below.

Braille: □Native language ( ) □English (Grade ) □Japanese

□Other (please specify : )

Sign language: □Native language ( ) □ASL □International

□Japanese □Other (please specify : )

Lip-reading: □Native language ( ) □English □Japanese

□Other (please specify : )

If you have any other communication skills, please describe below : I understand English.
24. Referee information – Give the name and contact details of your referee.

Name : Dr. Shakeel Ahmad Khan Relationship to you : My Professor

Address : [Link] college Jaranwala

Occupation : Associate Professor (teaching)

Email: shakeel890@[Link]

Telephone: N/A Mobile phone: +923006530442

25. Surety information – Give the name and contact details of your surety.

Name : Muhammad yousaf Relationship to you : Father

Address : Chak no 281 G.B Jaranwala Faisalabad Punjab pakistan

Occupation : Retired teacher and run self

business in agriculture Email: muhammadyousaf2829@[Link]

Telephone: N/A Mobile phone: +923467744966

26. Who completed this application form?

□ I completed this form by myself.

□ I got help – please give details on the person who completed this form on behalf of you.

Name : ZAHID IQBAL YOUSAF Relationship to you : SELF

Reason for assistance: I did not need any assistance during fill the form

27. Have you applied for this program before?

□ Yes, I applied in 20
□ No, this is my first time applying.

28. Do you have a valid passport?

□ Yes（Date of expiry：APR 25,2034 ）

□ No

29. Declaration statement by the applicant

“I hereby certify that all the information stated above is true, correct and complete.”
Your signature (or type your name): ZAHID IQBAL YOUSAF Date : JULY 24,2025