Application Form

IRTI Scholarship Program

Reference
No.
Family name:
Mohammad Yunus
Gender:

Date:

Name:Ruslan

Male

Nationality: Indonesia

Female

Academic Background
Degree
Name of discipline

Institution

Civil Engineering

University of Hasanuddin

Construction Management,
School of Civil Engineering
and Environment

Bandung Institute of
Technology

Other Information
What is your job at the time of
application?

Have you ever applied to IRTI

Scholarship Program in the past?
Yes

No

Language of correspondence:
Arabic
Current address:
Jl.Mutiara No. 58.C Palu, Central
Sulawesi

English

French

Permanent mailing address (if

different from current address):

Telephone number at current address: Other telephone numbers:

E-mail address:
Signature
I hereby agree to abide by IRTI regulations
governing scholarships, as described in IRTI
Scholarship Guide.
Applicant