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APPLICATION FORM
BALI INTERNATIONAL SUMMER SCHOOL 2013
Personal Details
Family Name :Muhammad
First Name :Azmi
Nick Name :Agung
Date of Birth : 4th Otober, 1991
Gender :Male
University :Malikussaleh University, Lhokseumawe
Current Academic Year :2010
Address :Jl Rel Kereta Api Cunda, Lhokseumawe
City/ Province :Lhokseumawe / Aceh
ZIP Code/ Postal Code :
Country :Indonesia
Telephone Number :085296895459
E-mail :[email protected]
Below are optional
Facebook : agungazmi
Twitter :azmiagung
Skype :
Yahoo Messenger :
Other Messenger :whatsup 08975606980
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Medical Information
Past History of Illness
(Such as allergy) :NO YES
If yes, please mention it :
Other Important
Are you vegetarian or not : a. Vegetarian b. Non-Vegetarian
Consideration of Your Food :
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MOTIVATION AND EXPECTED OUTCOMES
Motivation letter:
Dear Organizer Committee,
I am writing this letter to express my aspiration to participate in Bali Summer School
2013. My name is Muhammad Azmi Agung. I am a third year of medical student in
Malikussaleh University. While at school, I learned the importance of being independent in
a field I am passionate about. I tried to join some extracurriculars and to take severaltimes where I can upgrade knowledge. My faculty including one of the beginner among
other medical of schools in Indonesia. It is in Aceh, One of the province in Indonesia. It is
welknown of its beach, unique cultures, white-coral sand, forests, animals, and also some
stories behind that. I have discovered to visit some of that place through the social
activity which is held by campus regularly. They are still natural. However, we also find
some problems for making vacation. Infectious disease, harmful sunray ( it also related
global warming ), hygiene food, safe travelling and many others. For example in Sabang
Island which is welknown of its wonderful beach is an endemic malaria.
Therefore, as a medical student, i am highly motivated to participate to discuss insolving that kind of problems related to the Travel Medicine such as knowing earlier about
the description of disease, preventive, and also the treatment. I was interested to the
international event such a summer school which is presented all students whole over the
world. I hope the outcomes can be a self reminder for me to try contributing and sharing
to others in order that can be applied in Indonesia and Aceh it self.
I have completed the given application form and have verified that all statements in this
application are true and correct.
By submitting this application I agree with the Terms of Reference
*) Please attach:
- Scan of Student IDs
- Passport sized recent photo
- All over body photo
- Scan of passport (for Non-Indonesian citizens)
- Essay about Travel Medicine (regulations and guidelines attached
below)
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**) After fully fill this form, please send back to us to :
Email:[email protected]
We'll contact you to your email as soon as possible. If you have any other
question, please feel free contact us at:
Email :[email protected]
Twitter : @BISS_2013
Skype : bali_summerschool
Thank You
mailto:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]7/27/2019 Application Form BISS 2013 (1)
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Regulations and Guidelines of Essay
1. Eligibility ConditionEvery candidate of Bali International Summer School 2013
participants must submit an essay as one of requirements to apply
this program
2.Topic of The EssayTravel Medicine
3. Regulations of Writing The essay should be written in English (for all candidates) The essay contains facts and your own opinions about Travel
Medicine
Length of essay: 2-3 pages Format requirements: Typed on a A4 size electronic page Font: Times New Roman Font size: 12 points Line spacing: 1.5 lines
4. Essay Submission Requirements Submitted essays must meet all regulations of writing given above
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All essays must be submitted as an e-mail attachment [email protected] by the Application
Form and other requirements which have been mentioned before
mailto:[email protected]:[email protected]