APPLICATION FORM

PERSONAL INFORMATION
Name: Sandi Yudha Prawira

Date of Birth: November 14 1996

Address: Asrama Bumi Ganesha ITB, Bandung

Religion: Moslem

Languages Spoken: Indonesia, English

Phone:081321509253

Mobile: idm

Fax:-

Email Address: syudha71@gmail.com

Current Occupation: student

Passport Number: B0216955

Emergency Contact 082306697693

Facebook Account :sandi yudha

Twitter Account: sandiyudha1

EDUCATIONAL BACKGROUND
University

School/University
Bandung Institute
Technology

Years Attended/Degree Received

2014

Other Non-Degree

ORGANIZATIONAL AFFILIATION
Badan Pengurus Asrama Bumi
Ganesha ITB
Mahasiswa Teknik Material
Mahasiswa Islam Material
Keluarga Mahasiswa Islam ITB

Kepala Biro Relasi Asrama

dan Kampus
Maganger Kementrian
Sosial
Staff PSDA dan
Kekeluargaan
Staff Intrakampus

MEDICAL INFORMATION
Do you have any allergies? If yes,
please indicate.

no

Do you require any medication?

no

2016-2017
2015-2016
2015-2016
2016-2017

ADDITIONAL INFORMATION
What are your expectations from joining this program?
Actually, I know this information from my beloved teacher, the best teacher ever that Ive ever meet.
Just simple, I get new experience, new nakama(friends) not just from south sumatra but more than
that. I realize that I dont know much but what ever hehehehe.

What skills/knowledge can you share with your fellow participants to make the activity more
successful? I can dance but little hehehe, especially traditional dance from south sumatra cause I join
MUSI ITB(Mahasiswa Bumi Sriwijaya). I can singing but you know hehehe

What are your current hobbies and interests? Designing, browsing, business, basic engineering. etc

ESSAY
In 250 words, about your self and why you want to join this program
Oke I strat to introduce my self, My name Sandi Yudha Prawira. I from Lahat, south sumatra, 18
years old, last educational SMA N 4 LAHAT, now I got a chance to continue my study in one of the
best campus in Indonesia hehehe Alhamdulillah ya Min, ITB. I start study when 2014. Is that enough
heheehe?
Why I join this because of my teacher honestly. She just want me to join, force me to join. Last year
when I was the first grade in ITB she told me about this program. Just that

WAIVER
I,Sandi Yudha Prawira, am fully aware of my responsibilities as a participant . I
will follow the guidelines given for this activity and will not hold the facilitators or
the organization responsible for any untoward incident that I have caused or
incurred.

__________________________
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