iBuddies Application 2019

1. Full name
: .............................................................................
2. Place and date of birth
: .............................................................................
3. Gender : ............................................................................
.
4. Student Number
: .............................................................................
5. Nickname : ................................................................
.............
6. Email : ............................................................................
.
7. Phone number
: .............................................................................
8. Major : ............................................................................
.
9. Semester : ................................................................
.............
10. Latest GPA
: .............................................................................
11. Campus : ................................................................
.............
a) UAD Campus 1 (Kapas)
b) UAD Campus 2 (Pramuka)
c) UAD Campus 3 (Soepomo)
d) UAD Campus 4 (Ring Road)
e) UAD Campus 5 (Ki. Ageng Pemanahan)
f) UAD Campus 6 (Wates)
12. Languages : .....................................................................
13. Adress : .....................................................................
14. Hobby : .....................................................................
15. Organizational experiences :

No Organization Period
16. Have you ever joined any IO program?
a) Yes
b) No
If your answer is “YES”, please mention the name of the activity/ies

17. Why do you want to join this program?

18. Do you mind if you have more than one iBuddy?

a) Yes
b) No
19. Do you have preference about genderand/or citizenship of the international
students?
a) Yes
b) No
If your answer is “YES”, please mention the gender :

20. Write down your plan if if you get chosen to be iBuddy. Please be Specific!

21. How did you become aware of this program?

a) International Office Website
b) International Office Facebook/Twitter
 c) Pamphlet
d) Friend
e) Others: .....................................................................
22. Suggestion and comment

Date of application : .....................................................................

Applicant’s signature : .....................................................................
Applicant’s name : .....................................................................