Indonesia Mengglobal Mentee Application Form 2017

The mentorship program is only open for applicants who will apply to school overseas in the year 2017/2018. Selected mentees must submit an application to at least one school at the end of the program. If you are still not sure whether you will apply to school in 2017/2018, do not apply to this program.

Your responses will be shared only to the mentors within the mentorship circle. Once submitted, the application can not be edited. Application wil be received until 10 June 2017, 23.59 WIB. Afterwards, all submitted applications will go through two stages of screening process: Administration and Interview.

If you passed administration screening, you will receive an invitation for interview by 17 June 2017 and will be asked to provide a copy of Academic transcripts and Standardized test certificates (i.e. TOELF, IELTS, etc). Interviews will be conducted virtually by a panel consisting of two IM representatives and is scheduled from 17 June to 7 July 2017. Once all interviews have been conducted, selected mentees will be announced by 18 July 2017. Summary of important admission dates can be found below:

Date	Activity
Application Close	10 June 2017
Administration Screening Results/Interview Stage Invitation	17 June 2017
Interview Stage	17 June - 7 July 2017
Interview Results/Selected Mentees Announcement	18 July 2017
Mentorship Start	24 July 2017

All correspondence will be generated from the personal information submitted below. So, please use proper spelling, capitalization and punctuation.

More information about our mentorship program and FAQ, please go to our website at http://indonesiamengglobal.com/# or follow us on Twitter @IndoMengglobal. For further inquiries, you can also reach us at IM.Mentorship2017@gmail.com

Full Name*

First NameLast Name

Birthdate*

MonthDayYear

Mobile no.*

E-mail*

Where the confirmation will be send to

Skype ID

Google Plus ID

Are you an Indonesian citizen?*

YesNo

What level of university education are you applying for?*

BachelorMastersDoctoral (PhD)

What field best characterize the programs that you're planning to apply to?*

Please select from list

Which region is your top choice to study? *

List three programs that you intend to apply to.

Please research carefully before completing this part. These choices are not final, but will help us in matching you with the right mentors. As much as possible be coherent in your choices, eg. all three programs are similar and in the same level of university education.

Country 1*

University 1*

If not available, please type other and indicate in empty space below

Type of Program 1*

Name of Program 1*

Program

Country 2*

University 2*

If not available, please type other and indicate in empty space below

Type of Program 2*

Name of Program 2*

Program

Country 3*

University 3*

If not available, please type other and indicate in empty space below

Type of Program 3*

Name of Program 3*

Program

All applicants will be evaluated on the basis of academic merits, extracurricular and professional achievements, leadership potentials, fit to the programs applied, and indicated commitment to the mentorship program.

The mentorship program will require time commitment of at least five hours per week for the period between July to September 2017. Will you be committed to allocate the required time and work on all the assignments of the program?*

YesNo

Are you willing to accept and cooperate with any mentor who is assigned to you?*

YesNo

Are you willing to complete all the assignments that are assigned to you?*

YesNo

Are you committed to submit at least one completed application package to a school/program in 2017/2018 ?*

YesNo

Most communication throughout the mentorship program will take place over emails, Skype sessions, or phone calls. Are you committed to prepare technical arrangements to enable such communications, including to pay for your own communication expenses?*

YesNo

Most communication throughout the mentorship program will be in English. Are you comfortable in using English verbally and in writing throughout the program?*

YesNo

School application is a personal process, and we respect the rights of privacy of the selected mentees regarding their application. If you are selected, are you willing to maintain the anonimity of other selected mentees throughout and after the program?*

YesNo

Upon completion of the mentorship program, we would share school admission results to the public and ask each mentee to provide a testimony on their experience with Indonesia Mengglobal Mentorship program. If you are selected, are you willing to share your name and testimonial for publication in Indonesia Mengglobal's articles or social media channels?*

YesNo

School and scholarship applications can be costly to some. Will you need any financial assistance (outside of the scholarship fund you are applying for) to support your application? Eg. for IELTS/TOEFL test, GRE, SAT, or other costs associated. If yes, please specify in the column provided below*

YesNo

Name of of High School*

Country*

Month started*

Month ended*

Major

Class rank

GPA Score

Please write up to 2 decimals

GPA Scale

Highest score possible in your grading system

Undergraduate Degree Information

Country Undergraduate Degree Obtained*

Name of Institution (Domestic)*

If not available, please type other and indicate in empty space below

Other Institutions (Domestic)

Name of Institution (International)*

If not available, please type other and indicate in empty space below

Other Institutions (International)

Undergraduate Field of Study*

Please select from list

Undergraduate Major

Date Started*

Date Ended*

GPA Score*

Please write up to 2 decimals

GPA Scale*

Highest score possible in your grading system

Master Degree Information 1

Country Master Degree Obtained

Name of Institution (Domestic)

If not available, please type other and indicate in empty space below

Other Institutions (Domestic)

Name of Institution (International)

If not available, please type other and indicate in empty space below

Other Institutions (International)

Master Degree Field of Study

Please select from list

Master Degree Major

Date Started

Date Ended

GPA Score

Please write up to 2 decimals

GPA Scale

Highest score possible in your grading system

Master Degree Information 2

(Optional if you have a second Master Degree)

Country Master Degree Obtained

Name of Institution (Domestic)

If not available, please type other and indicate in empty space below

Other Institutions (Domestic)

Name of Institution (International)

If not available, please type other and indicate in empty space below

Other Institutions (International)

Master Degree Field of Study

Please select from list

Master Degree Major

Date Started

Date Ended

GPA Score

Please write up to 2 decimals

GPA Scale

Highest score possible in your grading system

Are you considering to apply or have applied for scholarships for enrollment in 2017? If yes, fill in the fields below.*

YesNo

1

Name of scholarship

Donor institution

Country

Status of application

2

Name of scholarship

Donor institution

Country

Status of application

List the highest scores of all standardized tests that you have taken in the past 2 years.

1

Language Proficiency Test

Test Name*

If not listed, please specify in empty space below

Total Composite Score*

Composite Score Scale*

Date Taken*

MonthDayYear

2

Other Proficiency Test

Test Name

If not listed, please specify in empty space below

Total Composite Score

Composite Score Scale

Date Taken

MonthDayYear

List only the three most substantial experiences. You have the freedom to list professional (internship included), research, school work, & volunteer experiences.

1

Name of Institution

Position

Month started

Month ended

Please explain responsibility and most substantial impact of this experience in no more than two sentences.

0/200

2

Name of institution

Position

Month started

Month ended

Please explain responsibility and most substantial impact of this experience in no more than two sentences.

0/200

3

Name of institution

Position

Month started

Month ended

Please explain responsibility and most substantial impact of this experience in no more than two sentences.

0/200

List your top three Awards and Achievements (i.e. deans list, scholarship, work acknowledgement, conference, publication etc).

1

Name of organization

Award or Achievement

Year Awarded

Level of Award

Award description and significance in no more than two sentences

0/200

2

Name of organization

Award or Achievement

Year Awarded

Level of Award

Award description and significance in no more than two sentences

0/200

3

Name of organization

Award or Achievement

Year Awarded

Level of Award

Award description and significance in no more than two sentences

0/200

In this essay, please tell us about why you are eager to apply for the IM Mentorship Program 2017: (1) What your future goal is (related to graduate studies), (2) how you think this mentorship would help you, (3) what steps you have taken to demonstrate that you are well-prepared for admission , and (4) what else you want us to know more about you for further consideration. Please make sure that you address questions (1), (2), and (3) in the essay, at a Maximum 500 words.*

0/500

Where did hear about this Mentorship Program from?*

Could you please specify which social media? (please choose one)*

By signing (typing your legal name) in the space below, you are certifying that all information is correct and that you are the person completing this application. You acknowledge that failure on your part to present accurate information may result in your withdrawal from the mentorship program. During the mentorship program, we also reserve the right to terminate any mentees who we found not committed to following the program schedule and rules. Please print this page for your records and retain it as verification of your application.*

Indonesia Mengglobal Mentee Application Form 2017

I. Personal Information

II. Academics

III. Scholarship

IV. Standardized Test Score

V. Work and Leadership Experience

VI. Awards and Achievements

VIII. Short Essay