ASTRA, a world of opportunities

APPLICATION
FORM

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Astra 1
Program
PERSONAL IDENTITY
Full Name: iif fakhrudin
Place & Date of Birth: Gresik, 21 November 1990
Address: jalan Harimau Blok PP no. 15 BTN PKT Bontang East Borneo

Email: iif_udin@yahoo.co.id
Phone Number: (0548) 23694
Mobile: +62-81330367621
EDUCATION BACKGROUND
High School : SMA YPK Bontang
University: Sepuluh Nopember
Institue of Technology, Surabaya
Faculty: Science
Major: Chemistry Department of
Science
Title of your final project: (if any)

GPA: Not Available

Semester: 6
Credits have been taken: Not available

Expected time of graduation (month and year): Not available

SPECIAL COURSE / TRAINING ATTENDED:

Yea
r

Course / Training

Place / Insitution

Remark

ASTRA, a world of opportunities

EXTRA CURRICULAR ACTIVITIES
(specify organizational activities you have attended within a
maximum of 2 years and showed the greatest contribution that you
provide)
Yea
r

Activities /
Organization

Organizat
ion
Scop

Positi
on
Hel

Responsibilities

WORK EXPERIENCE (Including part time job, freelance, internship, etc.)

Yea
r

Company

Position
Held

Responsiblities

SPECIAL AWARD
Please mention award(s) you have been received and explain it briefly
(academic honors, distinction, scholarship, etc)
Yea
r

Awar
d

Institution

Remar
ks

ASTRA, a world of opportunities

INTEREST
What do you usually do in your spare time?

PERSONAL EVALUATION
What make you different from others?

What would you consider need to be improved in yourself?

Would you like to participate in all programs provided during 1 year ?

YES

NO

How do you know about Astra 1

st

Program ?

University information
board Friends /
relatives
www.astra.co.id
other internet (facebook, email, mailing list, ......................)

Jakarta, ., 2011
Facebook: Astra Community
Twitter: AstraCommunity
Email: astra1st@ai.astra.co.id

(_______________________)
Signature & Full name

ASTRA, a world of opportunities

ACHIEVEMENT
Personally, what is your greatest achievement(s), how do you
accomplish it and why would you consider it as your greatest
achievement(s)
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ASTRA, A WORLD OF OPPORTUNITIES

MOTIVATION & PERSONAL STRENGTH

Explain to us, what is your biggest motivation(s) to join this program
st
and why we need to choose you as one of Astra 1 candidates.
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