S

APPLICATION FORM
BALI INTERNATIONAL SUMMER SCHOOL 2013
Personal Details
Family Name

First Name

Nick Name

Date of Birth

Gender

University

Current Academic Year

Address

City/ Province

ZIP Code/ Postal Code

Country

Telephone Number

E-mail

Below are optional

Facebook

Twitter

Skype

Yahoo Messenger

Other Messenger

Medical Information
Past History of Illness
(Such as allergy)

:NO

YES

If yes, please mention it :

Other Important
Are you vegetarian or not : a. Vegetarian
Consideration of Your Food

b. Non-Vegetarian

MOTIVATION AND EXPECTED OUTCOMES

Motivation letter:

I have completed the given application form and have verified

that all statements in this application are true and correct.
By submitting this application I agree with the Terms of Reference

*) Please attach:
- Scan of Student IDs
- Passport sized recent photo
- All over body photo

- Scan of passport (for Non-Indonesian citizens)

- Essay about Travel Medicine (regulations and guidelines attached
below)

**) After fully fill this form, please send back to us to :

Email: balisummerschool@gmail.com

We'll contact you to your email as soon as possible. If you have any other
question, please feel free contact us at:
Email

: balisummerschool@gmail.com

YM

: bali.summerschool@yahoo.com

Twitter

: @BISS_2013

Skype

: bali_summerschool

Thank You

Regulations and Guidelines of Essay

1. Eligibility Condition
Every

candidate

of

Bali

International

Summer

School

2013

participants must submit an essay as one of requirements to apply

this program

2. Topic of The Essay

Travel Medicine

3. Regulations of Writing

The essay should be written in English (for all candidates)

The essay contains facts and your own opinions about Travel
Medicine

Length of essay: 2-3 pages

Format requirements:
Typed on a A4 size electronic page
Font: Times New Roman
Font size: 12 points
Line spacing: 1.5 lines

4. Essay Submission Requirements

Submitted essays must meet all regulations of writing given above

All essays must be submitted as an e-mail attachment to

balisummerschool@gmail.comaccompanied

by

the

Application

Form and other requirements which have been mentioned before