You are on page 1of 1

GE Foundation Scholar – Leaders Program

Deadline: Applications must be send to IIEF by February 28, 2014 (post mark)

Certification for ____________________________________ [insert printed name of applicant] Application ID#: ID- ________________
By my signature below, I certify that I meet the basic eligibility requirements of the program and that the information provided is complete and accurate to the best of my knowledge. If requested, I agree to give proof of the information that I have given in my application. Falsification of information may result in termination of any scholarship granted. This application becomes the property of the Institute of International Education (IIE) and the Indonesian International Education Foundation (IIEF) upon submission. I also agree that, if selected as a GE Foundation Scholar-Leader, IIE/IIEF, GE and the GE Foundation may use my name, likeness and biographical information in promotion of the GE Foundation Scholar-Leaders Program, in any media whatsoever.

Signature of Applicant

Date

Additional Documents
Thank you for completing an application for the GE Foundation Scholar-Leaders Program in Indonesia. You are almost finished! In addition to the completed application, you are required to provide originals (where possible) or clear, certified photocopies of the documents listed below. For your application package to be considered complete, please ensure that you send the items below: Completed application form – signed and dated One (1) color photograph 4 x 6 cm – affix it in the provided box One (1) copy of valid Identification Card (KTP) Original official letter of enrollment from university One (1) certified copy (legalisir) of your university transcript records from semester 1 to 3 One (1) copy of high school diploma (Ijazah SMU) One (1) copy of high school transcript record (STTB) One (1) copy of high school transcript record – national standard (NEM) At least two (2) Letter of Reference from Academic Supervisor and other Faculty Member (submitted electronically by your recommenders in the online system), preferably from your English teacher at the university. One (1) letter of salary amount information of your parents for the last month (slip gaji) One (1) copy of family card (KK-Kartu Keluarga) Original letter of notification from campus or institution that you are involved in sosial and student activities (surat keterangan aktif di organisasi kemahasiswaan atau sosial lainnya yang asli dicap dan ditandatangan oleh kampus atau institusi) Your complete application package must be sent by February 28, 2014 (post mark), in order to be considered. Late or incomplete applications cannot be considered. Send to:

GE Foundation Scholar-Leaders Program – IIEF th Menara Imperium 28 Floor Suite B Jl. HR Rasuna Said Jakarta 12980, INDONESIA
All submissions become the property of the Institute of International Education. All data will be available only to members of the Institute of International Education and the selection panel. Financial information provided through this application will only be used for competition purposes and will be treated with the utmost confidentiality. Biographical information may be used in promotion of the program.

Institute of International Education