Application PPM SCHOOL OF MANAGEMENT THE FUTURE LEADERS Form

TITLE FULL NAME

APPLICATION FORM

Please complete the information below in block capitals and tick (P) the empty box

NICK NAME PLACE OF BIRTH DATE OF BIRTH / / RELIGION

DD/MM/YYYY

MARITAL STATUS HOME ADDRESS

PERSONAL DATA
PHONE

ZIP CODE FAX

PROVINCE

MOBILE PHONE

EMAIL

FAMILY
FATHER MOTHER BROTHERS/ SISTERS SEX

AGE

LAST EDUCATION

OCCUPATION

AGE

LAST EDUCATION

OCCUPATION

NUMBER OF BROTHERS/SISTERS WHERE DO YOU LIVE?

(PLEASE CHECK ONE ONLY)

COLLEGE
YEAR
To

COLLEGE/UNIVERSITY

CITY

SUBJECT

GPA

HIGH SCHOOL EDUCATION EDUCATION HISTORY

YEAR
To

NAME OF SCHOOL

CITY

TOEFL
INSTITUTE SCORE

fn. Application Form WM/fel

EMPLOYMENT HISTORY (FROM THE MOST RECENT) YEAR

TO

COMPANY COMPANY
TO

POSITION POSITION POSITION

EMPLOYMENT HISTORY

YEAR YEAR
TO

COMPANY

DO YOU EVER INVOLVE IN ORGANIZATIONAL ACTIVITY? ORGANIZATIONAL EXPERIENCE YEAR

TO (FROM THE MOST RECENT)

NAME OF ORGANIZATION NAME OF ORGANIZATION

TO

POSITION POSITION

SOCIAL ACTIVITY

YEAR

YEAR
TO

NAME OF ORGANIZATION

POSITION

PLEASE TELL US ABOUT YOUR ACHIEVEMENT AT SCHOOL, THE COMMUNITY, OR THE WORKPLACE KIND OF ACHIEVEMENTS YEAR To To To PLACE

OUTSTANDING ACHIEVEMENT

To To To To To To To

I, the undersigned, hereby apply for the Future Leader Program in Wijawiyata Manajemen (WM-PPM). If accepted, I agree to abide by all the rules and regulations of the PPM School of Management. All information contained herein is, to the best of my knowledge, true and complete. I do understand that I am subject to rejection or expulsion should any statement be omitted or

PERSONAL STATEMENT

PHOTOGRAPH
APPLICANT SIGNATURE

[DD/MM/YY]

APPLICANT PROFILE
TO KNOW ABOUT YOU
HOW DID YOU HEAR ABOUT THE FUTURE LEADER PROGRAM FOR THE FIRST TIME? (PLEASE CHECK ONE ONLY)

FRIEND

FAMILY

ROADSHOW

SOCIAL MEDIA

RADIO

MAILING LIST

NEWSPAPER

OTHER

fn. Application Form WM/fel