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Application Form Regular Program

This document is an application form for the Indonesian Arts and Culture Scholarship 2017 Regular Program. It requests personal details such as name, date of birth, nationality, passport information, address, education background, language skills, professional history, previous travels, and any special needs from applicants. The form is split into sections including personal details, academic background, language ability, professional history, travels, and special needs. Applicants are asked to fill in fields providing this information over 3 pages.

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Ian Nugraha
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39 views3 pages

Application Form Regular Program

This document is an application form for the Indonesian Arts and Culture Scholarship 2017 Regular Program. It requests personal details such as name, date of birth, nationality, passport information, address, education background, language skills, professional history, previous travels, and any special needs from applicants. The form is split into sections including personal details, academic background, language ability, professional history, travels, and special needs. Applicants are asked to fill in fields providing this information over 3 pages.

Uploaded by

Ian Nugraha
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
You are on page 1/ 3

MINISTRY OF FOREIGN AFFAIRS OF THE REPUBLIC OF INDONESIA

DIRECTORATE GENERAL OF INFORMATION


AND PUBLIC DIPLOMACY
Jl. Taman Pejambon No. 6 Jakarta Pusat 10110

INDONESIAN ARTS AND CULTURE SCHOLARSHIP 2017


(REGULAR PROGRAM)
Application Form

A. Personal Details
1.Name
a. Family name / Surname

b. First or given name(s)

2.a. Date of birth


d d - m m - y y
b. Place of birth

3. Sex Male Female

4. Nationality

5. Religion (optional)

6. Passport
a. Number

b. Date of issue
d d - m m - y y
c. Valid until
d d - m m - y y
7.a. Permanent address in home country

b. Telephone number (include country code)

c. e-mail address

Indonesian Arts and Culture Scholarship 2017 Application Form - Regular Program
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8. Marital status Single Married Widowed Divorced

9.a. Occupation

b. Name of employer or school

c. Address of employer or school

10. Person to be notified in case of an emergency


a. In Indonesia
i. Name

ii. Relationship

iii. Address

iv. Telephone number

b. In home country
i. Name

ii. Relationship

iii. Address

iv. Telephone number

Indonesian Arts and Culture Scholarship 2017 Application Form - Regular Program
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B. Academic Background

University / Higher Education Subject Degree obtained Year


Institution / expected

C. Language (insert mark where appropriate)

None Basic Conversational Fluent


Indonesian
English

D. Professional History

Company / Organization Position Year

E. Travels

Countries Reason Year

F. Special Needs (allergies, food restrictions, etc.)


_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________

Indonesian Arts and Culture Scholarship 2017 Application Form - Regular Program
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