Fostering ASEAN Future Leaders 2017/2018
STATEMENT OF INTENT TO RETURN
Name
Home University
Student ID
Course
Faculty
I am, hereby declaring that I will return to my homeland after the completion of the ASEAN
Leaders Fostering Program 2017/2018. The duration for the exchange programme is one year (2
semesters).
………………………………………………………………
(Applicant’s Signature)
Date: …………………………………………………….
Please provide us information of in charge whom we can contact.
Name __________________________Position ____________________________
Address _____________________________________________________________
___________________________________ Postal Code ____________________
Telephone _________________________ Fax ____________________________
Signature __________________________ Date ____________________________
Note: This form needs to be certified by the applicant’s home university through an official university stamp/seal.