Application Form

English Language Training Assistance (ELTA) - NTT

(Please complete the form in English)
Full name
Address
Handphone number
Email address
Age
GPA (S1)

Have you included a CV, a copy of academic transcript and KTP?

Yes

No

Do you intend to apply for other scholarship programs?

Yes

No

Yes

No

If YES which scholarship program/s?

Do you already have an English language proficiency score?
If YES what test is this?
What score did you achieve?
What month/year did you take this test?

Australia Awards - Indonesia

Wirausaha Building, 7th Floor, Jl. H.R. Rasuna Said Kav. C-5, Kuningan Jakarta 12940, Indonesia
Tel: +62 (021) 527 7648, Fax: +62 (021) 527 7649, ELTA@ialf.edu
www.australiaawardsindonesia.org

USE X

Are you employed?

Yes

No

If employed:
Name organisation/institution
Your employment status
(PNS/Non-PNS)
Job title within organisation
Period working within
organisation/institution
USE X
Have you informed your employer that you are applying for this training course?

Yes

No

Has your employer given you permission to apply for this training course?

Yes

No

Do you have written permission from the head of your organisation/institution to

participate in ELTA?

Yes

No

If Yes, please submit a permission letter from your Employer with your application
How did you get the information about ELTA?

Print media :
RRI advertisement
Timor Ekspress
Australia Awards Indonesia Website
Australia Awards AlumniSupervisor
Other
please specify.

Australia Awards - Indonesia

Wirausaha Building, 7th Floor, Jl. H.R. Rasuna Said Kav. C-5, Kuningan Jakarta 12940, Indonesia
Tel: +62 (021) 527 7648, Fax: +62 (021) 527 7649, ELTA@ialf.edu
www.australiaawardsindonesia.org