Documente Academic
Documente Profesional
Documente Cultură
ID6000392
MAHIDOL UNIVERSITY
REGISTRATION FORM FOR ACTIVE RECRUITEMENT 2017
Interview Venue:
Bali, Indonesia
Date:
9 March 2017
Jakarta Bali
PROGRAMMES
Expected Semester of Enrolment: 1/2017 (Start in August 2017 ) 2/2017 (Start in January 2018)
APPLICANT INFORMATION
Gender Female
Country of Nationality INDONESIA Passport Number
Date of Birth 24/01/1989 Age 28 years
Marital Status Single Married Divorced Widowed Separate
CONTACT INFORMATION
Jl. Gadjah Mada Lingkungan Nusantara No. 16 RT. 10/ RW. 04 Kel. Monggonao Kec. Mpunda
Address for Communication
Kota Bima NTB 84111
Phone Number +6282339519560
Mobile Number +6282339519560
Email dewinuranjani@gmail.com
ENGLISH PROFICIENCY
1. Please evaluate your overall English proficiency based on your actual performance (Minimum = 1 Maximum =10) *
1 2 3 4 5 6 7 8 9 10
EDUCATIONAL BACKGROUND
List all degrees you have previously received. Be arranged from the latest or highest level.
Degree Degrees Name Institute/ University Country Admission year Graduation year
Highest Degree bachelor of international relation degree brawijaya university INDONESIA 2007 2013
Other Degree (1)
Other Degree (2)
Unemployed
Self-employed
Part-time employee
Full-time employee
Position / Type of Responsibility
director
Name of Organization
Salaja Moci, Souvenir Shop and Social Activity
Type of Organization
Government
Government Enterprise
Company
University/College/School
Private
Other
Yes No
2. Scholarships Name
3. Organization
4. Type of Support
Full support
Partial Support
Other -
CAPACITY OF SELF-SUPPORT
In case of NOT being awarded any scholarship, are you able to provide a self-support?
(Average entire tuition fee for most two or three-year programmes is around 400,000-700,000THB)
Full scholarship
Partial scholarship
Tuition discount
Monthly allowance
Accommodation
Other
INTERVIEW RESULT
COMMENTS
Signature
(Interviewer)
Interview Venue:
Bali, Indonesia
Date:
9 March 2017