Stenden Form1

					Application form International Hospitality (Hotel) Management Program
Personal data
Please fill out in block letters

Family name male/female* First name(s) single/married*

Nationality Indonesian

other,...

Date of birth (dd/mm/yyyy)

Place and country of birth

Home address

Postal code

City

Country

Native speaker of (language)

Telephone
country city number

Fax
country city number

Mobile number
country number

Permanent address

Permanent postal code

City

Permanent country

Email

Passport number/KTP No.

Issue date (dd/mm/yyyy)

Expiry date (dd/mm/yyyy)

My email address can be used for commercial purposes, such as brochures and newsletters from Stenden University

Representative data
For students who applied through a representative: Name company Contact person

Email address

* Please encircle what applies to you

www.stenden.com/bali

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Application data
I want to apply for the following (tick one box only) :

Bachelor 4 year program:
International Hospitality (Hotel) Management (IHM)

Location:
Bali

English Language Course
Short course: 18 weeks Long course: 36 weeks Bali Bali

* Refund policy English Language Course The English Language Course services and expenses are contracted, based on the number of participants. Stenden University Bali therefore applies a strict non-refund policy on all English Language Course fees (no refund either for late arrival, early withdrawal or dismissal).

I prefer to start the chosen program/course in:
September 2009 February 2010 September 2010

How did you get to know about Stenden University Bali?
Stenden website www.stenden.com/bali Publication, please state which:

Education consultant or recruitment agent, please state name:

A student or alumni, please state name:

Visit of fair, presentation (name, date of fair)

Other:

www.stenden.com/bali

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Language abilities
What proof do you have of English Language competency?
Candidates, whose first language is not English, are required to take an English Language test, preferable IELTS or TOEFL For information on TOEFL and IELTS testing, please visit www.ielts.org and www.toefl.org IELTS: Score Date Score (dd/mm/yyyy)

TOEFL: Score

Date Score (dd/mm/yyyy)

English as language of instruction

Educational data
Concerns only your studies at the secondary school, university or professional levels.
Name of school/university Type of school Location Years attended Diploma GPA score

(awarded/to be awarded + year of graduation) to to to

(Grade Point Average from your education)

from from from

Accommodation
Do you need us to arrange accommodation for you? Yes No

Application procedure
Your application to Stenden University Bali will be considered upon receipt of this form, including all the supplementary documents. For an overview of our application deadlines, please check www.stenden.com/bali

Signature
I hereby certify that I have provided accurate information on this application. I understand that any misrepresentations or omissions of facts in my application may justify denial of admission, cancellation of admission or withdrawal from the program. This is my honest statement.

Date (dd/mm/yyyy)

Place

Signature

www.stenden.com/bali

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Checklist
Documents to be handed in:
A completed and signed application form Two copies of your passport (valid during at least one year upon arrival in Indonesia, for International Students) Original copy of IELTS or TOEFL results from attesting your knowledge of English Certifed copy*of your diploma (in English) of your school/college/university education Certifed copy of grades-sheet (in English) Curriculum Vitae (in English) Four recent passport-type colour photos Two full sized photographs (formal dress code) Two copies of your KTP (for Indonesian students) Copy of academic awards of honours, if available

* A certified copy, which is authentically signed and stamped by an authorized representative of your school/university to prove the authenticity of the copy.

Address
Please send the documents mentioned in the checklist to the following address:

STENDEN UNIVERSITY BALI
International Office Jalan Kubu Gunung, Banjar Tegal Jaya Dalung, Kuta Utara, Badung Bali 80361 Indonesia T +62 (0)361 412970 F +62 (0)361 439298 E-mail : maria.lee@stenden.com Website : www.stenden.com/bali

www.stenden.com/bali

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posted:11/13/2009
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