A joint program from
MIT Sloan School of Management and United in Diversity Forum

IDEAS Fellowships, 2008-2009
Application Form

IDEAS-Indonesia is an innovative program conducted in two phases. In phase one, IDEAS-Indonesia is presented by the Massachusetts Institute of Technology (MIT) Sloan School of Management in the USA. In phase two, IDEAS-Indonesia is presented by MIT Senior Lecturers and ELIAS Fellows. IDEAS-Indonesia is an integrated program: leading MIT and ELIAS Fellows who create and conduct IDEAS-Indonesia insure the integrated presentation of the experiential learning journey and develop competence to learn from the future, as it emerges.

PROGRAM APPLICATION                                               

Please answer all questions. Application must be fully completed by deadline in order to be considered. All answers must be in English. Please send completed application form, personal statement and CV to contact@unitedindiversity.org. All relevant information must be received by 15 July 2008..

Please type or print legibly.
GENERAL INFORMATION :

NAME:  *

NICKNAME OR PREFERRED NAME:              MALE             FEMALE

DATE OF BIRTH:     / / *
Day/Month/Year

ADDRESS:  

TELEPHONE (Mobile):                  TELEPHONE (Landline): 

E-MAIL:   *  

TITLE OR POSITION:                   DIVISION/DEPARTMENT (if applicable):  

ORGANIZATION:   


WORK EXPERIENCE:

Please list your positions starting with your current position. If all positions are in the same organization, please list the promotional sequence if applicable:
NAME OF ORGANIZATION  TITLE OR POSITION FROM (month/yr) TO (month/yr) 
/ /
/   /
/ /

PLEASE ESTIMATE TOTAL NUMBER OF YEARS OF PROFESSIONAL EXPERIENCE:

EDUCATION:
UNIVERSITY DEGREE YEAR
*

MARITAL STATUS:                         SINGLE                   MARRIED  
NUMBER OF CHILDREN:

LANGUAGE PROFICIENCY: *

In accordance with Massachusetts Institute of Technology policy, IDEAS - Indonesia does not discriminate against any person on the basis of race, color, sex, sexual orientation, religion, age, national or ethnic origin, political beliefs, veteran status, or disability in admission to, access to, treatment in, or employment in its programs and activities.

PERSONAL STATEMENT:  Please write a personal statement in English (not exceeding 500 words) stating why you would like to participate in a unique IDEAS leadership development program for Indonesia Leaders created jointly by MIT Sloan leading lecturers and UID Forum. Please clarify how would this be relevant toward your current work and academic or career goals. Describe any relevant interests and research/work experience.

*

Please attach your biography with this application submission
(DOC or PDF only)