Ilmenau University of Technology International Graduate School on Mobile Communications

Quadrocopter Girls Camp Undergraduate Application Form

Personal Data:

Photo (please in electronic form)

Family name: First name: Sex: Nationality: Date of birth: Place of birth: Current residency (postal address): Email: Phone (office/home): Educational Data: Name of school: Favourite subject(s) in school: Do you have concrete ideas for your post-school education/profession?

Wuri Handayani Wuri Female Indonesian 30 March 1992 Purworejo, Center of Java, Indonesia Jl.M.Alif RT 04 RW 05 Number 6, Kukusan Kelurahan, Beji, Depok 16425 Wuyu.miu92@yahoo.com 0857 158 52422

University of Indonesia Physics and Communication I want to show up about physics or sciences with interest packaging for all of people. Because many of them are traumatic and phobia with physics.

Please send a copy of your most recent school certificate with this questionnaire. Any additional information you would like to provide?

Agreement: I herewith agree to inform the TU Ilmenau immediately of any changes with respect to my application including withdrawal of my application or any delay in the process, etc.

Signature: Place, Date:Depok, 29 February 2012

Name: Wuri Handayani

Please return questionnaire by email to gs-girls.camp@tu-ilmenau.de