AS Student Services

Sydney Head Office, Sydney

Shop 2. 235-237 Anzac Parade Kensington NSW 2033 Australia
Tel. +61 2 9662 7429 | 9662 1769
Fax. +61 2 9663 0740

Contact person: Sylvia Sasmita
Email : sylvia@asstudent.com.au

Contact person: Bernard Huang
Email : info@asstudent.com.au

BSD Office, Tangerang

Kompleks Ruko Golden Boulevard Blok C no. 22 Jalan Pahlawan Seribu BSD City Tangerang 15322, Indonesia
Tel. +62 21 5316 0708 | +62 812 8582 6189

Contact person: Alice Wahyuni
Email : a.wahyuni@asstudent.co.id

Malibu Office, Medan

Jl. Nusa Alam Malibu Blk. A-61 Medan 20157, North Sumatra, Indonesia
Tel. +62 61 9100 6565
Fax. +62 61 786 7352

Contact person: Effendy Lie
Email : p.e.lie@asstudent.co.id

Cemara Office, Medan

Jl. Seroja Blk.C-3 No.14 Komp. Cemara Asri Medan 20371, North Sumatra, Indonesia
Tel. +62 61 9137 1333
Fax. +62 61 456 3225

Contact person: Wilsen Lau
Email : w.lau@asstudent.co.id

You can contact us directly or be in touch with us by filling this form below.

Basic Information

Family / Last Name

Given Name(s)

Gender

Male Female

Date of Birth

Email Address

Contact Number

Home address

City

State / Province

Country

Postal Code

Education Background

Recent Education Qualification

Course(s) Taken

Year of Study

Future Education Plan

What level of education are you interested in ?

What field of studies are you interested in ?

Which state / city / country are you interested in ?

What institution / school / university are you interested in ?

Additional Information

Will you be applying for Permanent Residency after completing your education ?

Yes No

Which AS Student Services offices / counsellors would you like to contact ?

How did you hear about AS Student Services ?

Education Expo / Seminar	Advertisement	Friends or Relatives
University Websites	Others:

Additional Comment

* The information collected on this form is confidential and strictly for internal use
by AS Student Services.