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ASIAN MEDICAL STUDENT`S ASSOCIATION-UNTAD

Head Office : Faculty of Medicine and Health Science Tadulako University


Kampus Bumi Tadulako Tondo JI. Soekarno Hatta Km. 9
TADULAKO UNIVERSITY

email: amsauntad@yahoo.co.id

UNTAD

Palu - Sulawesi Tengah 94118

Asian Medical Students


Association Tadulako University

Application Form for Representative of AMSA Tadulako University


General Information
Name

Name
Nickname

Place and Date of birth


Mobile Phone

3x4

Email
Program Study/University and Year
of Study

Participation in AMSA
Please mention all of AMSAs UNTAD and National activities that you have attended (Please mention your contribution)
Name of Event

Motivation
Please explain your motivation to join AMSA UNTAD and what are the benefits that youve got

Place and Date

ASIAN MEDICAL STUDENT`S ASSOCIATION-UNTAD


Head Office : Faculty of Medicine and Health Science Tadulako University
Kampus Bumi Tadulako Tondo JI. Soekarno Hatta Km. 9

UNTAD

email: amsauntad@yahoo.co.id

TADULAKO UNIVERSITY

Palu - Sulawesi Tengah 94118

Personal Experience
Please mention your personal experiences, activities that youve joined, and your achievements that make you feel you are eligible for this position and
hold a responsibilities as Representative of AMSA UNTAD. This experiences can be from organization, social activities, academic achievements, or
anything else.

Purpose of Application

ASIAN MEDICAL STUDENT`S ASSOCIATION-UNTAD


Head Office : Faculty of Medicine and Health Science Tadulako University
Kampus Bumi Tadulako Tondo JI. Soekarno Hatta Km. 9

UNTAD

email: amsauntad@yahoo.co.id

TADULAKO UNIVERSITY

Palu - Sulawesi Tengah 94118


Please describe what you know about AMSA UNTAD and its problem

Please explain why you are interesting in applying for this position, and please mention all of your new idea to build AMSA UNTAD and to solve the
problems that you want to realize in your period.

Please explain your vision and mission for AMSAs next

Please describe one of your program you give interest most that you want to do in your period

ASIAN MEDICAL STUDENT`S ASSOCIATION-UNTAD


Head Office : Faculty of Medicine and Health Science Tadulako University
Kampus Bumi Tadulako Tondo JI. Soekarno Hatta Km. 9

UNTAD

email: amsauntad@yahoo.co.id
Palu - Sulawesi Tengah 94118

Thank for your kind attention in


reviewing this application.
Place and Date :

Name

TADULAKO UNIVERSITY