Indonesian Internships

Program Application Form

Before filling out this form, it is essential that you take the time to view our Booking Conditions and check the box below. If you have any queries regarding these conditions, please contact us.

Indonesian Internship Program Booking Conditions

I have read and fully understand the attached booking conditions for Indonesian Internships programs.

Personal Details

Family
Name :

Given Name/s:

Sex:

Male Female

Date of Birth:

Nationality:

Passport No:

Place of Birth:

Home Address

Street:

Suburb/Town:

State:

Post Code:

Country:

Postal Address (If different from above)

Street:

Suburb/Town:

State:

Post Code:

Country:

Primary:

Secondary:

Telephone

Home:

Work: Mobile:

Release of Details to Other Participants

If you are coming on a group program, please check this box if you are happy for Indonesian Internships to pass on your name and email address to other people on your program.

Type, Beginning and Duration of Program
In which program would you like to participate? Group Program Individual Program
If Group Program: January 2009 June 2008 Other If Individual Program: Duration: If longer than 16 weeks: Beginning: 20 Please provide any extra information relating to the period of your individual program:
Internship Site Preferences and Information
Please number the boxes that are of interest to you, in order of preference. Note: only put a number next to the categories in which you would be happy to work. If you have a very strong preference, or there is any other extra information relating to these choices then include it in the large text area below.
Jounalism/Media		Teaching
AIDS Awareness		Social Work
Art/Design		Export/Import
Hospitality		Management
Community Development		Marketing
Accounting/Finance		Law
Healthcare/Nursing		Other (describe in text box below)
Please indicate which of the following best describes your current level of proficiency in bahasa Indonesia:
Oral:	Fluent Moderate Basic None
Written:	Fluent Moderate Basic None
Please provide any other information that you feel would be useful for us in selecting potential organisations for your internship (the more the better):

University Details

Are you a current university student?

No: You have finished your application. Please proceed to "What happens now?"

Yes: Please provide the following details

University Name:

Course Name:

Majors:

1. 2. 3.

Current year
of study:

1st 2nd 3rd 4th 5th

Earning a Credit Point on Program
Do you plan to earn a credit point from your university while on program?
	Yes No (Please proceed to "What happens now")
If yes, do you plan to earn credit through:
	The unit with Universitas Islam Indonesia (UII) A unit at your home university
If you will get credit through your home university, what is the name and code of the unit that you plan to complete?
Unit Name: Unit Code:
University:
Please provide any extra information relating to obtaining credit, either at UII or your home university.
What Happens Now?
We will contact you on the 'primary email address' that you have included in this form to confirm that we have received your application. If you have not received a reply within 4 working days of sending the application, please let us know at info@indonesianinternships.com.au. In our confirmation email we will include the details regarding the deposit payment of $150. Once this has been received we will continue in the process of sourcing the perfect internship site to complement your skills and interests.