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APPLICATION FORM 2008/2009

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

(Please tick as appropriate)

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

6 Kalimantan, Sulawesi, Papua

Position Held

Main Duties & Responsibilities

Date From To

4. WHICH SUBJECT(S) DO YOU PROPOSE TO STUDY IN THE UK?

5. WHY HAVE YOU CHOSEN THIS FIELD OF STUDY?

6. HOW DO YOU THINK STUDYING IN THE UK WILL AFFECT YOUR CAREER?

7. HOW WILL YOUR STUDYING IN THE UK BE OF BENEFIT TO INDONESIA GENERALLY?

8. WHAT JOB, OR POSITION, DO YOU HOPE TO HOLD IN TEN YEARS TIME?

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

Tel No. E-mail address

12. HAVE YOU BEEN AWARDED A CHEVENING SCHOLARSHIP BEFORE?


If yes, please give details

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

15. HOW DID YOU FIND OUT ABOUT CHEVENING?

16. IN WHICH CITY WOULD YOU PREFER TO BE INTERVIEWED?


Please tick Jakarta Medan Makassar

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 :

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