Scholarship Program 2019

Application Form

Please complete all parts of the form and submit to Admissios Office with supporting documents on or before
November 29, 2018.

APPLICANT

Full name : ______________________________________________________________________________________

Gender : ______________________________________________________________________________________

Date of Birth : / / (date/month/year) Place of Birth : _____________________________________

Nationality : ______________________________________________________________________________________

Address : ______________________________________________________________________________________

______________________________________________________________________________________

CURRENT SCHOOL

School Name : ______________________________________________________________________________________

Current Year : ______________________________________________________________________________________

Address : ______________________________________________________________________________________

__________________________________ E-mail : __________________________________________

GIFTED & TALENTED

Have you been part of a Gifted & Talented Programme or have any specific talents or abilities? Please list them here.

____________________________________________________________________________________________________

____________________________________________________________________________________________________

____________________________________________________________________________________________________

PARENTS
Father Mother

Full name : ________________________________ Full name : ________________________________

Nationality : ________________________________ Nationality : ________________________________

1st Language : ________________________________ Occupation : ________________________________

Phone : ________________________________
Occupation : ________________________________
E-mail : ________________________________
Phone : ________________________________

Work Address : ________________________________

E-mail : ________________________________
 Scholarship Program 2019
Application Form

PARENT CONSENT

I/We approve my child applying for a scholarship at AIS Indonesia for the 2019 School Year.

Parent’s signatures

______________________________ ______________________________ Date : ___ / ___ / ___

Father Mother

ADDITIONAL INFORMATION
Please Note:

Applications will only be processed upon receipt of all of the following documentation:
1. Completed Application Form
2. Copy of student Passport or proof of Nationality
3. Two passport size photos of student
4. School reports for the last 2 years
5. 500 word essay in English

Processing of Application: all the above documents should be submitted to Admissions Office.

By email to: scholarship@ais-indonesia.com

or

By post to:
Admissions Office
AIS Indonesia, Kemang Campus
Jl Kemang Timur No. 81
Kemang, Jakarta Selatan 12730

• You will be contacted within one week of receipt of application.

• Applicants will be invited to sit an online test in Mathematics and English between December 7-8, 2018.
• From this test applicants who are selected to proceed further will be invited to an interview with the Scholarship
Committee between December 11-12, 2018.
• Scholarship winners to be announced on December 14, 2018.