Request form

Esri Student License Software Request

at Institutions with a Campus-Wide Site License

Esri Indonesia offers ArcGIS for Desktop Student 1-year software and its extensions for use by
students, lecturers, researchers, and other academia at colleges and universities that are a part of
an Esri Educational site license and under Esri Indonesia education program MoU with Esri
Indonesia.

ArcGIS for Desktop version requested:

(If you do not know the version, please ask a universitys administrator)

Contact information

Customer number :
(Filled in by Esri Indonesia)

Prefix : Mr. / Mrs. / Ms. / Miss. / Dr. / Prof. / Hon.

Name :
(First name) (Last name)

Student number / NIP :

Job title :

Organization :

Department :

Address :

City :

Province :

ZIP Code :

Phone : Ext:

Email :

(Preferred institutional email)

 Request form

What is/will be your primary use of GIS?

What GIS classes are you teaching (for lecturers) / taking (for students) this year?

Please describe some ways in which you use Esri GIS software to teach your students (for
lecturers):

If you would like to provide more information about how your school is using GIS, please do
so here:

If you are having question regarding this form, please send any questions or comments to
edu@esriindonesia.co.id

Esri Indonesia values your privacy.