APPLICATION FOR SCHOLARSHIP

PERSONAL DATA
Full Name :
Photo
3x4 cm
Present Address :
Permanent Address :
Telephone :
E-mail Address :
Place & Date of Birth :
Se : Male / Female
FA!"L# DATA
Name A$e Education Occupation
Father
!other
Si%lin$& '
(
)
*
+
ED,-AT"ON BA-./RO,ND
School From - To Name & Location of School !a0or -ourse
/raduated1 De$ree
Recei2ed
/PA
Elementar3
4r5 6i$h
Sr5 6i$h
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OR/AN"7AT"ONAL A-T"8"T"ES
Name of Or$ani9ation1 Acti2ities From - To Position
TRA"N"N/1 -O,RSE1 APPRENT"-ES6"P RE-ORDS
.ind of Trainin$1 -ourse1
Apprenticeship
From - To Or$ani9ed B3 Location
A-T"8"T"ES & 6OBB"ES
!em%ership of
Professional Association
6o%%ies & Sports
Social Acti2ities
ADD"T"ONAL "NFOR!AT"ON :if an3;
The facts stated in this Scholarship Form are true and complete to the best of my knowledge and belief.
I understand and agree to follow all the procedures, regulations, and requirements that related to Total E& Indonesie!s Scholarship
rogram.
"ate# $pplicant!s Signature#
%.&# lease supply all of this documents, along with this form#
'opy of academic transcripts, from (
st
semester until the last semester.
( photo )*+, cm-.
'opy of T.EF/ certificate
Name
,ni2ersit3
!a0or
<6# " <ANT TO -ONT"N,E !# ST,D# "N FRAN-E =
!# PROFESS"ONAL PLANS=
<6# TOTAL S6O,LD /RANT !E A S-6OLARS6"P=
DES-R"PT"ON OF 6"/6ER ST,D#