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National Board

BAPIN ISMKI 2017-2018


Application Form
No: ____ (fulfilled by functionary)

Instructions
Thank you for showing your interest in BAPIN-ISMKI. Once you have read the form
and are interested in applying, please follow these steps below:
1. Complete all sections of this application form in English (preferred) or Bahasa
Indonesia.
2. Only shortlisted applicants will be contacted.

Contact Person :
Zaufy : zaufyvos / 085733729196
Arya : ak7148 / 089661058313

Badan Analisis dan Pengembangan Ilmiah Nasional


Ikatan Senat Mahasiswa Kedokteran Indonesia
Jl. G.S.S.Y Sam Ratulangie 28, Jakarta Pusat, Indonesia
bapinismki@yahoo.com | @bapin_ismki I FB : Bapin ISMKI
PART 1: PERSONAL INFORMATION
Full Name
Nick Name
Gender Nationality
Date of Birth Place of Birth
Home Address
Current Address
Phone Number Mobile Number
Email
Faculty
Major Batch
Line Account Facebook Account

Badan Analisis dan Pengembangan Ilmiah Nasional


Ikatan Senat Mahasiswa Kedokteran Indonesia
Jl. G.S.S.Y Sam Ratulangie 28, Jakarta Pusat, Indonesia
bapinismki@yahoo.com | @bapin_ismki I FB : Bapin ISMKI
PART 2: GENERAL QUESTION
1. What is your motivation applying for National Officer of BAPIN-ISMKI?

2. What is your opinion about Leadership?

3. What is your strength(s)? How you can use your strength in daily life?

4. What is your weakness(es)? How do you overcome your weakness(es)?

Badan Analisis dan Pengembangan Ilmiah Nasional


Ikatan Senat Mahasiswa Kedokteran Indonesia
Jl. G.S.S.Y Sam Ratulangie 28, Jakarta Pusat, Indonesia
bapinismki@yahoo.com | @bapin_ismki I FB : Bapin ISMKI
5. What did you know about BAPIN-ISMKI and ISMKI?

Badan Analisis dan Pengembangan Ilmiah Nasional


Ikatan Senat Mahasiswa Kedokteran Indonesia
Jl. G.S.S.Y Sam Ratulangie 28, Jakarta Pusat, Indonesia
bapinismki@yahoo.com | @bapin_ismki I FB : Bapin ISMKI
PART 3: EXPERIENCE INFORMATION
Work/Committee Experience (if any)
Name of Company/ Responsibilities/ Brief Description Duration in Weeks
NGO/Institute Position of Work /Months

Leadership Experience (if any)


School/ Organisation/ Responsibilities/ Brief Description Duration in Weeks
Project Position of Work /Months

Mention one advanced hobby and other general hobbies/interests:


Advanced Hobby
General Hobbies / Interests

Your Personal Achievements So Far:

Career Goal(s):

One Personal Failure So Far:

Badan Analisis dan Pengembangan Ilmiah Nasional


Ikatan Senat Mahasiswa Kedokteran Indonesia
Jl. G.S.S.Y Sam Ratulangie 28, Jakarta Pusat, Indonesia
bapinismki@yahoo.com | @bapin_ismki I FB : Bapin ISMKI
PART 4: OPPORTUNITIES FIELD
How did you get to know about BAPIN ISMKI?
☐BAPIN-ISMKI Event
☐Friends/Family/Relations
☐Facebook
☐Twitter
☐Line
☐Others (mention) : _______________________

What is your specific skill(s)? (if any) (you can choose more than one)
☐ Communication Skill
☐ Design Skill
☐ Event / Project Management
☐ Finance and Business Skill
☐ Human Resources Management
☐ Marketing and Selling Skill
☐ Public Speaking

What do you want to learn in BAPIN ISMKI? (you can choose more than one)
☐ Communication Skill
☐ Design Skill
☐ Event / Project Management
☐ Finance and Business Skill
☐ Human Resources Management
☐ Marketing and Selling Skill
☐ Public Speaking
☐ Networking

How would you like to engage with BAPIN ISMKI? (you can choose more than
one)
☐Member of BAPIN ISMKI
☐Manage and Handle Events in BAPIN ISMKI
Badan Analisis dan Pengembangan Ilmiah Nasional
Ikatan Senat Mahasiswa Kedokteran Indonesia
Jl. G.S.S.Y Sam Ratulangie 28, Jakarta Pusat, Indonesia
bapinismki@yahoo.com | @bapin_ismki I FB : Bapin ISMKI
☐Doing or Handle Research activities in BAPIN ISMKI
☐Virtual Volunteering
☐Others (mention) ____________________________:

Type of Mobility
☐Bike
☐Motorbike, Car
☐Public Transportation

Badan Analisis dan Pengembangan Ilmiah Nasional


Ikatan Senat Mahasiswa Kedokteran Indonesia
Jl. G.S.S.Y Sam Ratulangie 28, Jakarta Pusat, Indonesia
bapinismki@yahoo.com | @bapin_ismki I FB : Bapin ISMKI
PART 5: ESSAY
Tell us about your self (minimum : 250 words)

Badan Analisis dan Pengembangan Ilmiah Nasional


Ikatan Senat Mahasiswa Kedokteran Indonesia
Jl. G.S.S.Y Sam Ratulangie 28, Jakarta Pusat, Indonesia
bapinismki@yahoo.com | @bapin_ismki I FB : Bapin ISMKI

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