FULBRIGHT

FOREIGN LANGUAGE
TEACHING ASSISTANT
(FLTA)
PRELIMINARY
APPLICATION FORM
ADELINE WIDYASTUTI
 FULBRIGHT PRELIMINARY APPLICATION FORM

FULBRIGHT FLTA
PRELIMINARY APPLICATION FORM Affix your recent
self
(PLEASE TYPE, DO NOT WRITE) 3 x 4 cm
photograph
in this box.

PERSONAL INFORMATION

NAME
Please provide your name as it appears on your ID (KTP/Passport)
Prefix Choose an item.
(Dr./Mr./Mrs./Ms.) :
First/Given Name : Click or tap here to enter text.
Middle Name(s) : Click or tap here to enter text.
Last/Family Name : Click or tap here to enter text.
Suffix (Jr./Sr.I/II/II) : Choose an item.

NAME ON PREVIOUS RECORD

Please provide your name if listed on previous records differently than above.
First/Given Name : Click or tap here to enter text.
Middle Name(s) : Click or tap here to enter text.
Last/Family Name : Click or tap here to enter text.

BIOGRAPHICAL INFORMATION
Birthdate (e.g. 01 May Click or tap to enter a date.
1980) :

City of Birth Click or tap here to enter text.

:
Country of Birth Click or tap here to enter text.
:
Sex (male/female) Click or tap here to enter text.

:
Physical Impairment Click or tap here to enter text.
:

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 FULBRIGHT PRELIMINARY APPLICATION FORM

Please describe any physical impairment you may have. (This information is gathered for statistical purposes and
to ensure appropriate placement. The Fulbright Program does not discriminate on the basis of physical
impairment).

CITIZENSHIP INFORMATION
Country of Citizenship Click or tap here to enter text.
:
Additional Countries in Which You Hold Click or tap here to enter text.
Citizenship:
Country of Permanent Residence Click or tap here to enter text.
:
National Identification Number (KTP/Passport) Click or tap here to enter text.
:

U.S INFORMATION
Do you now or have you ever held:
U.S. Citizenship?
☐ Yes ☐ No
U.S. Dual Citizenship? 
☐ Yes ☐ No
U.S. Permanent Residency?
☐ Yes ☐ No
Do you have a diversity visa lottery application pending?
☐ Yes ☐ No
Have you ever applied for U.S. permanent residency? 
☐ Yes ☐ No

CONTACT INFORMATION

ADDRESSES
Permanent Address (DO NOT TRANSLATE the address into English)
Country : Click or tap here to enter text.
Street : Click or tap here to enter text.

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 FULBRIGHT PRELIMINARY APPLICATION FORM

City : Click or tap here to enter text.

State/Province Click or tap here to enter text.
:
Postal Code : Click or tap here to enter text.

Current Mailing Address (DO NOT TRANSLATE the address into English)
Country : Click or tap here to enter text.
Street : Click or tap here to enter text.
City : Click or tap here to enter text.
State/Province Click or tap here to enter text.
:
Postal Code : Click or tap here to enter text.
Valid From : Click or tap to enter a date.
Valid To : Click or tap to enter a date.

TELEPHONE NUMBERS
Please be sure to include the local code along with your number (e.g. +62812345678, 021 8789995)
Cell Phone Number Click or tap here to enter text.
1 :
Cell Phone Number Click or tap here to enter text.
2 :
Home Phone Click or tap here to enter text.
Number :
Work Phone Click or tap here to enter text.
Number :

E-MAIL
Please provide a primary and secondary email address (e.g. professional, university, etc.) in case we
have difficulties contacting you at the primary email address. Please note that all system-generated
messages will be sent to the primary e-mail address.
Primary : Click or tap here to enter text.
Secondary : Click or tap here to enter text.

EMERGENCY CONTACT INFORMATION

The individuals listed below may be contacted in the event of an emergency while undertaking
activities related to this grant opportunity, including any possible travel required for interviews in

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 FULBRIGHT PRELIMINARY APPLICATION FORM

Indonesia.
First/Given Name : Click or tap here to enter text.
Last/Family Name : Click or tap here to enter text.
Country : Click or tap here to enter text.
Street : Click or tap here to enter text.
City : Click or tap here to enter text.
State/Province Click or tap here to enter text.
:
Postal Code : Click or tap here to enter text.
Phone Number : Click or tap here to enter text.
E-mail : Click or tap here to enter text.
Relationship to You Click or tap here to enter text.
:

First/Given Name : Click or tap here to enter text.

Last/Family Name : Click or tap here to enter text.
Country : Click or tap here to enter text.
Street : Click or tap here to enter text.
City : Click or tap here to enter text.
State/Province Click or tap here to enter text.
:
Postal Code : Click or tap here to enter text.
Phone Number : Click or tap here to enter text.
E-mail : Click or tap here to enter text.
Relationship to You Click or tap here to enter text.
:

ACADEMIC HISTORY

List all post-secondary educational institutions you have attended in reverse chronological order,
including any in which you may be presently enrolled.
Institution 1 Click or tap here to enter text.
:
Level of Study Click or tap here to enter text.
:

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 FULBRIGHT PRELIMINARY APPLICATION FORM

Country Click or tap here to enter text.

:
City Click or tap here to enter text.
:
Name of Diploma or Click or tap here to enter text.
Degree Equivalent (e.g.
BA/MA/MFA):
Actual Name of Degree or Click or tap here to enter text.
Diploma
:
Discipline Click or tap here to enter text.
:
Enrolled From Click or tap to enter a date.
:
Enrolled To Click or tap to enter a date.
:
Date Degree Received Click or tap here to enter text.
:
If a degree is in progress, list expected date of conferral for Date Degree Received.

Institution 2 Click or tap here to enter text.

:
Level of Study Click or tap here to enter text.
:
Country Click or tap here to enter text.
:
City Click or tap here to enter text.
:
Name of Diploma or Click or tap here to enter text.
Degree Equivalent (e.g.
BA/MA/MFA):
Actual Name of Degree or Click or tap here to enter text.
Diploma
:
Discipline Click or tap here to enter text.
:
Enrolled From Click or tap to enter a date.
:
Enrolled To Click or tap to enter a date.
:
Date Degree Received Click or tap here to enter text.
:

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 FULBRIGHT PRELIMINARY APPLICATION FORM

If a degree is in progress, list expected date of conferral for Date Degree Received.

Institution 3 Click or tap here to enter text.

:
Level of Study Click or tap here to enter text.
:
Country Click or tap here to enter text.
:
City Click or tap here to enter text.
:
Name of Diploma or Click or tap here to enter text.
Degree Equivalent (e.g.
BA/MA/MFA):
Actual Name of Degree or Click or tap here to enter text.
Diploma
:
Discipline Click or tap here to enter text.
:
Enrolled From Click or tap to enter a date.
:
Enrolled To Click or tap to enter a date.
:
Date Degree Received Click or tap here to enter text.
:
If a degree is in progress, list expected date of conferral for Date Degree Received.

EMPLOYMENT HISTORY

List your work experience since university graduation. Start with the most current one.
Work 1
Organization Name Click or tap here to enter text.
:
Country Click or tap here to enter text.
:
City Click or tap here to enter text.
:
State/Province Click or tap here to enter text.
:
Dates of From: Click or tap to enter a date. To: Click or tap to enter a date.
Employment :

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 FULBRIGHT PRELIMINARY APPLICATION FORM

If you are currently employed, please leave the End Date field blank
Starting Position Click or tap here to enter text.
:
Ending Position Click or tap here to enter text.
:

Description
:

Reasons for
Leaving :

Work 2
Organization Name Click or tap here to enter text.
:
Country Click or tap here to enter text.
:
City Click or tap here to enter text.
:
State/Province
:
Dates of From: Click or tap to enter a date. To: Click or tap to enter a date.
Employment :
If you are currently employed, please leave the End Date field blank
Starting Position Click or tap here to enter text.
:
Ending Position Click or tap here to enter text.
:

Description
:

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Reasons for
Leaving :

Work 3
Organization Name Click or tap here to enter text.
:
Country Click or tap here to enter text.
:
City Click or tap here to enter text.
:
State/Province
:
Dates of From: Click or tap to enter a date. To: Click or tap to enter a date.
Employment :
If you are currently employed, please leave the End Date field blank
Starting Position Click or tap here to enter text.
:
Ending Position Click or tap here to enter text.
:

Description
:

Reasons for
Leaving :

EXAM SCORES

Attach a photocopy of each test. Test results should not be older than 2 years.
Test Score Test Date (dd/mm/yy) Location
TOEFL
☐ Internet-Based (iBT) Click or tap here Click or tap to enter a Click or tap here to enter
to enter text. date. text.
☐ Institutional (ITP) Click or tap here Click or tap to enter a Click or tap here to enter

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 FULBRIGHT PRELIMINARY APPLICATION FORM

to enter text. date. text.

IELTS Click or tap here Click or tap to enter a Click or tap here to enter
to enter text. date. text.
OTHER Click or tap here Click or tap to enter a Click or tap here to enter
to enter text. date. text.
EXPERIENCE ABROAD

If you have traveled, lived, or studied in any country other than your own for more than a month,
please list this experience below. This can include time overseas for education, research, business,
vacation, etc․
Country 1 Click or tap here to enter text.
:
Start Date : Click or tap to enter a date.

End Date : Click or tap to enter a date.

Description :

Country 2 : Click or tap here to enter text.

Start Date : Click or tap to enter a date.

End Date : Click or tap to enter a date.

Description :

Country 3 : Click or tap here to enter text.

Start Date : Click or tap to enter a date.

End Date : Click or tap to enter a date.

Description :

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 FULBRIGHT PRELIMINARY APPLICATION FORM

Have you recently entered the United States on a J-1 or J-2 visa?
☐ Yes ☐ No
If YES, please select the J category of sponsorship.
☐ Au Pair ☐ International Visitor ☐ Short-Term Scholar
☐ Camp Counselor ☐ Physician ☐ Specialist
☐ College and University ☐ Professor ☐ Summer Work Travel
Student ☐ Research Scholar ☐ Teacher
☐ Government Visitor ☐ Secondary School ☐ Trainee
☐ Intern Student

PREVIOUS FULBRIGHT GRANT(S)

Have you previously been awarded a Fulbright grant?
☐ Yes ☐ No

If you have previously been awarded a Fulbright grant, please list the grant(s) below.
Award Type/Name Click or tap here to enter text.
:
Previous Grant Click or tap here to enter text.
Year :

Award Type/Name Click or tap here to enter text.

:
Previous Grant Click or tap here to enter text.
Year :

FLTA INFORMATION

LANGUAGE SKILLS
Please rate your English language proficiency as Native, Advanced, Intermediate, Beginner or
No Ability in three categories below.
Proficiency in Indonesian Language
☐ No Ability
☐ Beginner
☐ Intermediate
☐ Advance
☐ Native

Mother Tongue (Native) Language : Click or tap here to enter text.

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Please rate your overall level of English Proficiency.

☐ No Ability
☐ Beginner
☐ Intermediate
☐ Advance
☐ Native

PREFERENCES
Please choose your preferences.
In your role as a language assistant on a U.S. university campus, you are willing to 
☐ Perform actual classroom teaching duties
☐ Be primarily assistant
☐ Both teach and assist

Is there a particular region in the U.S. that interests you?

☐ West ☐ Northeast
☐ Midwest ☐ Southeast
☐ Southwest ☐ N/A I would accept all

Candidates for the FLTA program are matched with U.S. colleges and universities of all types
(small/large, urban/rural, etc.). The best candidates for the program can be effective in and make the
most of any environment. 

Is there any college or university type which you would most prefer? If you believe you are
adaptable, please respond N/A
☐ Single gender student body
☐ Urban location
☐ Rural location
☐ Small population
☐ Large population
☐ Little ethnic diversity
☐ Great ethnic diversity
☐ Offers coursework on an audit basis
☐ Require specific coursework on a credit basis
☐ N/A I would accept all

Is there any college or university type which you would refuse an offer assistantship? If you believe

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you are adaptable, please respond N/A.

☐ Single gender student body
☐ Urban location
☐ Rural location
☐ Small population
☐ Large population
☐ Little ethnic diversity
☐ Great ethnic diversity
☐ Offers coursework on an audit basis
☐ Require specific coursework on a credit basis
☐ N/A I would accept all

TEACHING EXPERIENCE
If you currently or previously held language teaching positions, please quantify your total amount of
teaching experience AFTER university graduation.
Click or tap here to enter text. Years Click or tap here to enter text. month

INTEREST
ACADEMIC INTERESTS: The FLTA Program is a non-degree program which offers coursework for
enrichment purposes. Select 2-3 areas of academic study that you feel would contribute to your
development as a language professional. Please note: the subjects you indicate are not guaranteed
should you be selected for the FLTA Program. Topics you select give you an opportunity to express
your academic interests.
Academic Interest Click or tap here to enter text.
1 :
Academic Interest Click or tap here to enter text.
2 :
Academic Interest Click or tap here to enter text.
3 :

NON-ACADEMIC INTERESTS: Please list any non-academic interests (e.g. sports, music, art, etc.).
Include information about your experience in these areas. 

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ESSAYS AND OBJECTIVES

PLAGIARISM AGREEMENT*

The Fulbright Program seeks applicants that have developed a sense of personal integrity and are
original thinkers. The following application includes several opportunities to express your own thoughts,
ideas, and opinions in essay responses. Plagiarism in any of your answers to these questions will
result in your disqualification from participating in the program.

From the Oxford English Dictionary:

"Plagiarism is the wrongful appropriation or purloining and publication as one's own, of the ideas, or the
expression of the ideas of another."

Plagiarism will be understood to include any of the following:

Presenting wording, statistics or concepts as your own which should be attributed to someone else or to
publications (online or offline). This includes, but is not limited to:

 Copying the exact wording of a written source

 Presenting material with alterations in wording
 Paraphrasing the content of a source without citation

It is expected that your responses to essay questions in the application will be your own work, and that
use of outside sources will be kept to a minimum. Applicants do not have to use secondary sources for
essays. However, any sources used in the construction of your responses must be cited.

By indicating 'Yes' in the question below, you are acknowledging that you understand both what actions
constitute plagiarism in this application, and the consequences resulting from any plagiarism found in
your submission.
I have reviewed and understand the above information on the importance of presenting my own original
work in the Fulbright Program application. I agree to properly cite any outside sources from which I take
words or ideas in the composition of my essay responses. I understand any falsification or plagiarism
found in my Fulbright application will result in my dismissal from the Fulbright Program.

☐ Yes
☐ No

OBJECTIVES AND MOTIVATIONS

Please write in a separate piece of paper. (Do not exceed two pages, single space)
Write a clear and detailed description of your objectives and motivations. Please write a well-
structured essay that addresses your background and qualifications for the program, past
experiences that have been formative in your personal development, reasons for applying to the
program, and how being an FLTA will assist you in achieving your long term career goals. Please do

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not insert your actual CV or resume in this section.

TEACHING METHODOLOGIES AND TECHNIQUES

You may be asked to teach your own class. If so, what teaching methodologies and techniques would
you utilize to teach your language to U.S. students? This brief essay should focus on the language you
will be teaching in the U.S. (not English). Mention any innovative approaches you have utilized as a
teacher or encountered as a learner that you may employ.

SHARING YOUR CULTURE

As an FLTA you will act as a cultural ambassador of your country. What do you think it means to be a
cultural ambassador? Elaborate on your answer by selecting one of these scenarios and explaining
how you would share your culture. 1) A guest lecture at your host institution 2) An international
festival 3) Volunteering at a local youth center. Please do not insert your actual CV or resume in this
section.
This short essay should be your own unique ideas. It is recommended you keep quotations and the
use of outside sources to a minimum. However, if you decide to use quotes or information from an
outside source, you must include a citation for each one utilized (this refers to websites as well).

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OTHER SCHOLARSHIPS

If you are currently applying for other scholarship programs or holding any other scholarship, please
specify program and status of your application (including Fulbright and other AMINEF administered
scholarship programs). Be specific.
Name of Click or tap here to enter text.
Scholarship :
Sponsor/Facilitator Click or tap here to enter text.
:
Program Level Click or tap here to enter text.
:
Date Applied Click or tap to enter a date.
:
Date Received Click or tap to enter a date.
:
Status Click or tap here to enter text.
:

Name of Click or tap here to enter text.

Scholarship :
Sponsor/Facilitator Click or tap here to enter text.
:
Program Level Click or tap here to enter text.
:
Date Applied Click or tap to enter a date.
:
Date Received Click or tap to enter a date.

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 FULBRIGHT PRELIMINARY APPLICATION FORM

:
Status Click or tap here to enter text.
:

Name of Click or tap here to enter text.

Scholarship :
Sponsor/Facilitator Click or tap here to enter text.
:
Program Level Click or tap here to enter text.
:
Date Applied Click or tap to enter a date.
:
Date Received Click or tap to enter a date.
:
Status Click or tap here to enter text.
:

ADDITIONAL INFORMATION

MEMBERSHIP
List professional, societal, fraternities or other organizations in which you now hold membership or
in which you have been active in the past. (Indicate if you have held an elective office):
Institution Name 1 Click or tap here to enter text.
:
Location Click or tap here to enter text.
:
Date From/To Click or tap to enter a date. To: Click or tap to enter a date.
:
Position Click or tap here to enter text.
:
Responsibility Click or tap here to enter text.
:

Institution Name 2 Click or tap here to enter text.

:
Location Click or tap here to enter text.
:
Date From/To Click or tap to enter a date. To: Click or tap to enter a date.
:

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Position Click or tap here to enter text.

:
Responsibility Click or tap here to enter text.
:

Institution Name 3 Click or tap here to enter text.

:
Location Click or tap here to enter text.
:
Date From/To Click or tap to enter a date. To: Click or tap to enter a date.
:
Position Click or tap here to enter text.
:
Responsibility Click or tap here to enter text.
:

OTHER GRANTS AND AWARDS

List scholarships or fellowships held at present or in the past. Give source or sponsor, amount, where
held, duration, and year.

Indicate academic honors or prizes which you have received.

Are you pursuing any other scholarship, fellowship or employment that would supersede your
participation in the FLTA program should it be offered? Please explain: 

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OUTREACH SURVEY
Have you participated in any of the U.S. Government sponsored programs listed below?
☐ English Access Micro Scholarship

☐ Global Undergraduate Scholarship (UGRAD)

☐ Kennedy-Lugar Youth Exchange & Study Program (YES)

☐ Future Leaders Exchange Program (FLEX)

☐ Study of the U.S. Summer Institute

☐ Summer Institute for Young Leaders

☐ Muskie Fellowship

☐ Humphrey Fellowship

☐ Undergraduate Intensive English Language Scholarship

☐ Timor or South Pacific Scholarship

☐ Community College Initiative (CCI) Program

☐ Other Click or tap here to enter text.

How did you learn about FLTA program.

☐ Friends/Relatives ☐ Fulbright ☐ Poster/Flyer ☐ University ☐ Newspaper
Alumnus
☐ Other publication ☐ AMINEF Website ☐ Other website ☐ Social Media ☐ U.S. Embassy
☐ Other Click or tap here to enter text.

How long did you consider applying for the FLTA award before submitting this application? (please put the number of
years)
Click or tap here to enter text. years

What were the major factors in helping you decide to apply for the FLTA award?
☐ Reputation of the Fulbright Program
☐ Publicity about the program
☐ Advice of a colleague
☐ Advice of a former Fulbrighter
☐ Time was right in my career
☐ Other Click or tap here to enter text.

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RECOMMENDATIONS

List the two persons from whom you have requested a letter of reference. This letter of reference
must be written by a teacher/lecturer under whom the applicant has studied in the proposed field of
study or by someone who has supervised the applicant in work related to the proposed program. This
letter must be in English. If not in English, then an accurate translation must be forwarded to the
Fulbright Program Office. A specific format and instruction for this letter is available at AMINEF
website.

The letter must describe the applicant's qualifications and potential for successfully completing
further academic study in the U.S, including:
 Applicant's outstanding talents
 How he or she compares with peers, both
academically or in leadership roles Observation
on the applicant's character
 Other comments or relevant insights that you can offer that are not likely available from other
sources.

Recommender 1
Prefix : Click or tap here to enter text.
First Name : Click or tap here to enter text.
Last Name : Click or tap here to enter text.
Institution : Click or tap here to enter text.
Position/Title Click or tap here to enter text.
:
Relationship : Click or tap here to enter text.
Telephone : Click or tap here to enter text.
Email : Click or tap here to enter text.

Recommender 2
Prefix : Click or tap here to enter text.
First Name : Click or tap here to enter text.
Last Name : Click or tap here to enter text.
Institution : Click or tap here to enter text.
Position/itle : Click or tap here to enter text.
Relationship : Click or tap here to enter text.
Telephone : Click or tap here to enter text.
Email : Click or tap here to enter text.

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FULBRIGHT PRELIMINARY APPLICATION FORM

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DECLARATION

 I hereby certify that the information I have provided on this application form and in any attached
materials is accurate, complete and true to the best of my knowledge and belief, and I agree to
notify AMINEF of any change in the above information or of any further information that might
affect my eligibility for consideration as a prospective recipient of the Fulbright Scholarship
award.
 I understand that by completing this application form there is no assurance that I will be
awarded a grant.
 I understand that the scholarship offered is for the chosen and approved field and level of study
program and I will not change my enrollment without consent from AMINEF and its cooperatives.
 I understand that no additional grant or study will be considered under this scholarship.
 I understand I will meet all the course requirements of the US education institution based on the
approved length of the grant awarded.
 I understand I am not permitted to engage in employment beyond the J visa restriction and
without consent from AMINEF and its cooperatives.
 I understand that I will return home upon the completion of my study as per J visa policy of the
Two-Year Home Country Residence Requirement.
 I understand that I will not be eligible to continue my Fulbright selection process if I am
accepting another scholarship program.
 I understand that grant funds are not sufficient to cover travel or support for my family and I will
make necessary arrangements for the living expenses in Indonesia while I am away or in the U.S.
if they wish to join me.
 I have no objection to publicity about my selection for a Fulbright Scholarship.

Signature: Date:
_____________________________________________

The Fulbright educational exchange and the Hubert H. Humphrey program have been active in
Indonesia since 1952 and 1979 respectively, with hundreds of notables from Indonesia’s academic
community and key figures from the governmental, private and cultural sectors having traveled and
studied in the United States. The American Indonesian Exchange Foundation (AMINEF) was
established in 1987 to bring a higher level of cooperation and local involvement to the Fulbright
Program. AMINEF runs an open, merit-based competition for Fulbright grants. Applications are
reviewed by AMINEF selection team. Those applicants who meet the minimum standards of the
program are then interviewed by a binational selection committee that includes experts from their
fields. The recommendations of the selection committee are reviewed by AMINEF Board of
Management. That list is then sent to the J. William Fulbright Foreign Scholarships Board in
Washington for final approval.

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 FULBRIGHT PRELIMINARY APPLICATION FORM

RETURN THE COMPLETED APPLICATION AND SUPPORTING DOCUMENTS TO:

AMERICAN INDONESIAN EXCHANGE FOUNDATION (AMINEF)

Intiland Tower, 11th Floor
Jl. Jend. Sudirman 32
Jakarta 10220

APPLICATION CAN BE RETRIEVED FROM:

www.aminef.or.id

FOR ANY INQUIRIES:

Ph. (021) 5793-9085/86

Fax. (021) 5793-9089
E-mail: [email protected]

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 FULBRIGHT PRELIMINARY APPLICATION FORM

CHECK LIST
Please check if you have attached the following documents in support of your application

NO REQUIRED ITEMS DESCRIPTION COMPLETED

1. Application Complete application form, please type, do not
write
2. Objective and See the application pg. 11 for details
Motivation
3. Original Letters of Obtain two (2) from your supervisor, lecturer, or
Reference professor who knows you well. You may send the
letter in a sealed envelope and send it along with
your application or have the persons who give you
the reference to send it directly to AMINEF.
4. Copy of Academic Official, certified copies of your academic records
Transcripts* for all post-secondary institutions attended; must
list courses taken and grades received for each
year of enrollment
5. Original translation of If your official transcripts are not issued in English,
transcripts have official transcripts translated into English:
must be literal, not interpretative
6. Copy of Diploma(s)* Official, certified copies of your diploma(s) for all
post-secondary institutions attended in original
language
7. Original translation of If your diploma(s) are not issued in English, have
diploma(s) diploma(s) translated into English: must be literal,
not interpretative
8. Copy of Standardized Copy of most recent, less than 2 years old test
tests TOEFL/IELTS* result
9. Copy of National ID Copy of both or either one and the ID
(KTP)/Passport* (KTP)/passport is still valid
10. Copy of lecturer’s letter SK includes rights and obligations from the
of appointment (SK university and which is signed by the Rector or
Pengangkatan) or SK chairman of the foundation
PNS if civil servant*
11. Curriculum Vitae Provide the current one

* Do not attach original documents, only certified copies.

THIS FORM IS TO BE FILLED OUT COMPLETELY AND ACCURATELY.

WE REGRET INCOMPLETE APPLICATION WILL NOT BE CONSIDERED.

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