Scholarship Program 2017

Application Form

Please complete all parts of the form and submit to Admissios Office with supporting 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 : ________________________________ Full name : ________________________________

Nationality : ________________________________ Nationality : ________________________________

1st Language : ________________________________ Occupation : ________________________________

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

Work Address : ________________________________

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

______________________________ ______________________________ 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 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.