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LV Brunei Darussalam 1. Universiti Brunei Darussalam Cambodia 2. Royal Ur:1iversity of Phnom Penh 3. Royal University of Law and Economics Indonesia 4. Universitas Gadjah Mada 5. Universitas Indonesia 6. InstitUl Teknologi Bandung 7. Universitas Air1angga Lao PDR. 8. National University of Laos Malaysia 9. Universiti Malaya 10. Universiti Sains Malaysia 11. Universiti Kebangsaan Malaysia 12. Universiti Putra Malaysia 13. Universiti Utara Malaysia Myanmar 14. Yangon Institute of Economics 15. University of Yangon 16. University of Mandalay The Philippines 17. De La Salle University 18. University of the Philippines 19. Ateneo de Manila University Singapore 20. National University of Singapore 21. Nanyang Technological University 22. Singapore Management University Vietnam 23. Vietnam National University. Hanoi 24. Vietnam National University. Ho Chi Minh 25. Can Tho University
Language Profieiency - English Language proficiency test (please specify): TOEFL (CBTI PBT IIBT) I IELTS Score: As of Date: ---------- --------------. - Others (if any) Score: -------------------- Interested host universities (please specify your interested institution and discipline in order of preference) 1. University: -------------------~-- Faculty I Institute I College: ~ Country: ~ 2. University: ------------------------ Faculty I Institute / College: -,-- Country: ~ 3. University: Faculty I Institute / College: Country: D D Semester: 1sl Semester Semester *** Please refer to the summary on academic calendar ofaun member universities prior to choosing your preference. For more information, please visit: http./lacts.ui.ac.idl *** 2 nd 2
How do you think your study abroad during the exchange programme would enhance your study and personal experience? 4
I hereby certify that the above statements are true and that pe-:mission from my parents to apply for this scholarship and to accept the offer to join the exchange! study program abroad has been granted. Applicant's signature: ( ) Date : ---- --------- Remarks: Applicants are required to submit relevant documents in one complete package: 1) A complete application form with photo attached 2) A nomination letter endorsed by Dean / Director of relevant Faculty /College 3) Letter from registration office (to certify that applicant is a current student registered with the University) 4) An official transcript 5) 1-2 page CV 6) Language Proficiency Test Application Deadline: 15 March 2016 6