APPLICATION INFORMATION

IN-COUNTRY SHORT COURSE

A. INSTRUCTIONS FOR THE APPLICANT:

  • Answer questions 1 through 7clearly and completely, in English, typewritten. Do not change the lay out of the original form.
  • You will receive confirmation of receipt of your application within 2 weeks after he deadline by e-mail.
  • You may submit one application only (apply for one course only). Submiting more than one application (more than one course) leads to disqualification.
  • The secelction will be held in Apr 2013 and the result will be announced to the applicants at the latest by end of May 2013.
  • Failure to react to Nuffic Neso Indonesia’s correspondence/e-mail within 48 hours can lead to cancellation of the scholarship.
  • There will be no correspondence about submitted forms.
  • If at any time after award of the scholarship it becomes clear that the applicant has made inacurate or incorrect declarations in the application, the scholarship offer will immediately be revoked.
  • TWO SETS ofthe application form and documentation are required.
  • Application form and documents will not be returned

B. ENCLOSURES:

Attach only certified copies of documents.

  • Admission letter by course provider for the course you are applying;
  • Certificate of `TOEFL Internet-Based Test Examinee Score Report’ minimum68 or `International English Language Testing System Test Report Form (IELTS Report Form)’ minimum score5.5 only for the course conducted in English;
  • Curriculum vitae, see format on website;
  • Copy SK for government officials or ‘kontrak kerja’ for others;
  • Legalized copies of original diplomas and transcripts;
  • Copy of KTP
  • 1 recent photograph (3x4; colour)

The closing date is 1Mar2013

Applications received after the closing date and incomplete application will not be processed.

Two complete sets of application should be submitted. Completion in stages is not possible.

APPLICATION FORM

IN-COUNTRY SHORT COURSE 2013

TO BE FILLED IN BY APPLICANT

name:
male  female 

email 1 :

email 2 :
FOR OFFICIAL USE ONLY
Documents / Y / N
Application form
Employer statement
Applicant’s declaration
Admission letter
IBT/IELTS
CV
SK
Original diploma
Original transcript
KTP
Eligibility / Y / N
2 years working exp.
Full time / Part time
Employer statement
SK
GPA
IBT/IELTS
Study abroad
Admission letter
Chosen programme
Tuition fee
Co-sharing
StuNed/NFP awardee
Selection
Partner
MIB
F / M
Java / Outside java
Total score
Final Result / Y / N
Scholarship Award

GPA:S1 S2
GPA MAX GPA MAX

IBT / IELTS: test date:
For course in English

chosen programme:
course provider:

duration: days

employer:
(name of institution)

city:

province:

employed since: (dd/mmm/yyyy)

applicants position:

position held since: (dd/mmm/yyyy)

APPLICATION FORM

IN-COUNTRY SHORT COURSE 2013

Please note that any false and/or incomplete declaration will lead to the termination of the StuNed scholarship. It is not allowed to extend or change the available space for each question, except for question 5.

1. PERSONAL INFORMATION

All data exactly as they (will) appear in your ID !

Name / Male  Female 
Place/Date of Birth / Place: / Date:
Marital Status / Single  Married  / Children 
Email Address / 1. / 2.
Home Address
Telephone / Fax / Mobile
* obligatory / Home *:
Mobile Phone *:
Parents’ address
(or next of kin)
Telephone / E-mail
2. THE COURSE FOR WHICH YOU HAVE BEEN ADMITTED
Please enclose the admission letter by course provider.
Name of course provider
Name of course
Period of this course / From: Until: / Duration : days
Name of contact person / email
Total tuition fee / EUR

3. EDUCATIONAL RECORD

a. Undergraduate Education

Please enclose certified copies of relevant diplomas and transcripts

Name of institution
Place of Institution
Field of study
Diploma or degree obtained /  S-1 (or equivalent) Year of graduation …… GPA……….

b.Postgraduate Education & Training

Please enclose certified copies of relevant diplomas, degrees, certificates and transcripts.

Name and place of institution
Duration / From: Until:
Main field of study
Diploma or degree obtained /  S-2  Master’s Degree  Other

4. PRESENT EMPLOYMENT

Name of Institution / Company / Organisation (Faculty/Department)
Address / Telephone:
Fax:
E-mail Address:
Website:
Brief description of Institution / Company / Organisation (Faculty/Department)
Present position
This position held since / (dd/mmm/yyyy)
Employment for / hours a week
Describe your current duties and
responsibilities

5. MOTIVATION STATEMENT

The statement should be typewritten and composed only by the applicant him/herself.

No. / Criteria / Explanation
A. / Explain in 100 words the relevance of the chosen course to your personal and career development
B. / Explain in 100 words the relevance of the chosen course to the current development of your organization (long term development plan) and the sector you work in.

6. MISCELLANEOUS

How did you find out about the StuNed Scholarship Programme for the very first time? / (TICK ONLY ONE ITEM)
Nuffic NesoIndonesia website
Nuffic NesoIndonesia presentation at the Neso office
Nuffic Neso Indonesia presentation at your office
Article in print media (please indicate ………………………)
Advertisement in print media (please indicate ……………..)
Radio (please indicate…………………………)
Holland Education Fair (HEF) / European Higher Education Fair (EHEF)
Your institution
Friends
StuNed alumnus
StuNed brochure/poster
Nuffic NesoIndonesia office
Others (please Indicate ……………...... …)
Where/How did you get the information about the study programme for which you apply? / (TICK ONLY ONE ITEM)
List of courses on the Neso website
Holland Education Fair (HEF) / European Higher Education Fair (EHEF)
Nuffic website
Course providerwebsite
Friends
Your institution
Nuffic Neso Indonesia office
Others (please indicate...... )
Have you applied for StuNed Scholarship Programme before? / No
Yes, year……………..
Have you ever been awarded a scholarship? /  Yes  No
If so, from which organisation/donor?
For what period, for which course/institution and in which country has it been granted?
For which other scholarship programme(s) are you also applying at this moment?

7. STATEMENT BY THE EMPLOYER

I, the undersigned, being authorised to supply the following particulars hereby certifies that Mr/Mrs/Miss.:
and is applying for a StuNed scholarship to follow a short course in the field of / name of course :
Name of course provider : / Name of Applicant:
is employed by our organisation since:
Department:
Position: for hours a week
Position held since:
Please explain fully why the course is important to your organisation (and to the applicant’s work in the future):
Do you guarantee that, if the candidate is awarded with the scholarship, he/she will be given permission to attend the course for the entire period of the programme?
Do you guarantee that, if the candidate is awarded with the scholarship, he/she will continue to be employed by your organisation after completion of her/his study?

I certify that all my answers are true, complete and correct, and that if the candidate is awarded a StuNed scholarship, my organization will comply with all the formal obligations this entails.

Name (of organization):

Name (of contact person):

Position:

Date:

Place:

Signature and official stamp: (please sign on ‘materai’)

8. APPLICANT’S DECLARATION

THE ORIGINAL APPLICATION FORM AND ITS ANNEXES SHOULD BE SENT TO:

Nuffic NesoIndonesia

Menara Jamsostek 20th Floor

Jalan Jend. Gatot Subroto No.38

Jakarta 12710

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