Young Scholars Award Entry Form

Please fill in this entry form, sign at the bottom and include it with your entry. Please email your
completed entry to marketing@esriindonesia.co.id.

Section 1: Entrant details

Date of birth: / / Title:

Name:

Address:

Suburb: State: Postcode:

Home phone: Mobile:

Email:

Section 2: Education details

Type of degree (e.g. Bachelor of Applied Geographical Information Systems):

Institution (e.g. University of Indonesia):

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 2017 Young Scholars Award Terms and Conditions stated on the Esri Indonesia
website, and I give permission for Esri to display my work at the 2017 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 field below).

Student name: Student signature:

Date:

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