Applicants should read the British Chevening Awards scheme requirements before completing this form. Please use block capitals and BLACK ink or typescript. Please DO NOT attach CVs or resumes or any other papers instead of completing any section of the application form. Please submit the completed application form by email to chevening@britishcouncil.or.id, mail or hand delivery to British Council offices in Jakarta not later than 30 September 2007 Photocopied versions of the application form are acceptable Please submit ONE copy of your application only
1. PERSONAL DETAIL
Surname/Family Name Title (Mr/Mrs/Ms etc) Place/Date of Birth Present Address
Permanent Address
(if different from above)
Region
2. EDUCATION
Name of institution
3. EMPLOYMENT
Company/Institution Name
O C
Start date End date
1 Jabotabek
2 Jawa Barat
(excluding Jabotabek)
H O T N
First/Given Names Sex Male Email Telephone Number Fax Number Nationality Mobile-phone Number 3 4 Jogyakarta, Jawa Jawa Timur, Bali, Tengah Lombok, NTB, NTT 5 Sumatera Qualification obtained Subject/Field of Study GPA
Position Held
Date From To
O C
H O T N
9. THIS SCHEME IS HIGHLY COMPETITIVE. WHY SHOULD YOU BE CHOSEN FROM AMONG MANY GOOD APPLICANTS?
10. HOBBIES/INTERESTS
Please explain what you do with your spare time and why
11. REFEREES
Give names of two people who are willing to provide a letter of recommendation. Referees should be able to comment on either your academic or professional career.
Name Designation
Address
13. HAVE YOU BEEN INVITED FOR A CHEVENING INTERVIEW BEFORE? 14. HAVE YOU EVER BEEN AWARDED A SCHOLARSHIP?
If yes, please give details
O C
Surabaya
H O T N
Name Designation Address Tel No. E-mail address
YES
NO
YES YES
NO NO
17. PLEASE GIVE DETAILS OF TWO EXPERIENCES WHICH HAVE MOST INFLUENCED YOUR LIFE AND EXPLAIN WHY
I understand that these details may be shared with other parties involved in this scholarship scheme
SIGNATURE..
O C
H O T N
DATE :