Happy Digital X Application Form

HAPPY DIGITAL X: CITIES, SYSTEMS, PRODUCTS AND SERVICES

APPLICATION FORM
Welcome to "Happy Digital X: Cities, Systems, Products and Service" and thank you for your interest in applying for our program!

Before you fill out the registration form below, please be mindful that all data/information you share here will entirely be our responsibility as the program selection committee. We will not use the data/information other than for the need of program selection and without your knowledge.

Applicants from the Government sector may be required to enclose a Letter of Assignment from their respective institution.

Should you require further information about our program please visit our website at https://happydigitalx.tsea.asia/ or contact us via email at uidbc@uid.or.id.
Personal Information
Full Name*

First NameSurname
Email Address*
Gender*
Date of Birth*

DayMonthYear
Mailing Address*

Street Address 1

Street Address 2

CityProvince

PostcodeCountry
Phone Number*
Citizenship*
Occupation *
Organization*
Sectoral Representation (please select up to two options)*

GovermentBusinessNGOAcademiaMediaICTOther
Professional Experience

Please fill in up to 3 (three) of your most recent and/or relevant professional experiences.

	Organization/Company/ Institution Name	Title	Grade (if applicable)	Duration of Employment (years)
1
2
3

Trainings and Professional Certifications

You may fill up to 3 (three) of your most recent and/or relevant trainings and professional certifications.

	Training/Certification Name	Organizer	Year of Completion	Certificate Number (if applicable)
1
2
3

You may attach a separate portfolio document containing your training/professional certification (optional).

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Please upload your most recent CV*

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Awards and Recognitions

You may fill in up to 3 (three) of your most recent and/or relevant professional awards and recognitions.

You may attach a separate portfolio document containing your professional award/recognition certificates (optional).

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Skills and Competencies

Please answer the following questions on your skills and competencies. The information you provide will help us develop and deliver the best learning experience for every participant.
1. English Proficiency Level*

BasicConversationalBusinessNative
2. ICT Proficiency Level*

BasicIntermediateExpert
In what capacity would you best define your ICT proficiency?

UserSystem AdministratorSystem Designer
What software do you have experience in using?
What other ICT-related experience do you have?
Short Essay

Please write a short answer for each of the following 2 (two) essay prompts.
Essay 1: In 200 words or less, please share with us your vision of happy digital communities, systems, products and services.*

0/200
Essay 2: In 200 words or less, please share with us your experience in creating systems, products and/or services. What were the barriers that you have encountered? How did you overcome them?*

0/200
You may attach a separate portfolio document (up to two pages) containing information on your system, product and/or service (optional).

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References

Please provide 2 (two) referees below.

Referee Details*

	Name	Title	Organization/Company/Institution	Relationship with Applicant	Years of Relationship	Referee Email
1
2

May the organizer contact your referees for further information?*
Happy Digital X Program Tuition Fees, Payments, and Financial Aids

The program fees are USD 6,900/IDR 97,000,000 for participants from business sector and USD 5,900/IDR 83,000,000 for non-profit and government institutions. It should be paid by the participants once they have passed the selection process. The tuition as above is for the 2021 Pilot Program—an online program with offline orientation opportunities. Full payment is due two weeks after Letter of Acceptance is sent to the admitted participants.
Are you in a non-business sector and/or financial challenge and requiring scholarship to be able to join this program? (Limited scholarships are available and will be awarded based on a needs assessment) *
If “Yes”, please refer to the scholarship application form that can be accessed at https://bit.ly/HDXScholarship.
Declaration*

I certify that I have read the instructions and understood the questions on this form and that the answers provided are true and correct.I understand that I am responsible for payment of all tuition fees by the due dates.I declare my commitment to fully and actively participate in the entirety of the program.
Signature

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Personal Information