Ais Ib Scholarship Application Form 2017 Fa 1f622b

Scholarship Program 2017 Application Form

Please complete all parts of the form and submit to issios Office with ing documents on or before November 4th, 2016.

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 : ________________________________ Nationality : ________________________________

Full name : ________________________________ Nationality : ________________________________

1st Language : ________________________________

Occupation : ________________________________

Occupation : ________________________________ Phone

: ________________________________

Work Address : ________________________________ E-mail

: ________________________________

Phone

: ________________________________

E-mail

: ________________________________

Scholarship Program 2017 Application Form

PARENT CONSENT I/We approve my child applying for a scholarship at AIS Indonesia for the 2017 School Year. Parent’s signatures

______________________________ Father

______________________________ Mother

Date : ___ / ___ / ___

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 port or proof of Nationality 3. Two port 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 issions Office. By email to: [email protected] or By post to: issions Office AIS Indonesia, Kemang Campus Jl Kemang Timur No. 81 Kemang, Jakarta Selatan 12730

You will be ed within one week of receipt of application. Applicants will be invited to sit an online test in Mathematics and English in November 2016. From this test applicants who are selected to proceed further will be invited to an interview in late January. Scholarship winners to be announced in December 2016.