Young Scholars Award Entry Form

Please fill in this entry form, sign at the bottom and include it with your entry. You can email your
completed entry to marketing@esriindonesia.co.id or post it to Esri Indonesia Young Scholars Award,
Menara 165, 6th Floor Unit B, Jalan TB Simatupang Kav 1, Jakarta Selatan 12560.

Section 1: Entrant details

Date of birth:

Title:

Name:
Address:
Suburb:

State:

Home phone:

Mobile:

Postcode:

Email:

Section 2: Education details

Type of degree (e.g. Bachelor of Applied Geographical Information Systems):
Institution (e.g. Queensland University of Technology):

Program code:

Location:

Student ID number:

Section 3: Does your entry include the following:

Your Young Scholars entry (software development/application or report);
A written response (no more than 500 words) outlining the purpose of your project; an overview of its value; and

an outline of why you should be the Indonesian Esri Young Scholar;
An image illustrating your project or report (e.g. map image must be 300dpi and a .pdf or .png file);
Proof you are currently enrolled as a student at an Indonesian university in the form of a letter from your

lecturer/tutor and a photocopy of your university ID; and,
A signed copy of this entry form.


Section 4: Student consent

I have read and understand the 2016 Young Scholars Award Terms and Conditions as stated on the

EsriIndonesia website, and I give permission for Esri to display my work at the 2016 Esri International User
Conference. I also agree to participate in, and for Esri Indonesia to use my work in promotional activities
including, but not limited to, public relations and media. (Note: Your nomination will not be accepted unless
you agree to this condition. Agreement is provided by signing in the fieldbelow).
Student name:
Date:

PT Esri Indonesia, 02.194.245.3-011.000 | Copyright PT Esri Indonesia

Student signature: