Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
Personal Information
Name:
_____________________________________________________________________________________________
Citizenship:
__________________________________________________________________________________________
Mailing Address:
____________________________________________________________________________________
_____________________________________________________________________________________________________
_____________________________________________________________ (Home)/Cell-phone:
_____________________
M.A. PROGRAM
PH.D. PROGRAM
RESEARCH PROGRAMS
FULBRIGHT-DIKTI DOCTORAL DISSERTATION RESEARCH (DDR) AWARD PROGRAM. (Applicants must have
completed the required coursework. Please put a check mark (V), if you ___Have outlined
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FULBRIGHT-DIKTI PRELIMINARY APPLICATION FORM
dissertation proposal; ___Have a dissertation adviser in Indonesia (please attach a letter of support
from the adviser);___Have contacted American university for potential adviser.)
Academic History**
University/Institute Attended after High School Years Attended Degree
Obtained/Expected GPA/IPK
From To (incl. Field of Study)
____________________ _______________________________________________________________________________
____________________ _______________________________________________________________________________
Standardized Test Scores (Please attach a photocopy of each test. Test results should not be older than 2 years)
Degree student candidates must take the Graduate Record Examination (GRE for all fields except Law and
Business) or Graduate Management Admission Test (GMAT for business administration, finance, accounting) if
they are selected. It is recommended that applicants begin to familiarize themselves with the above test.
Professional History**
List your work experience since university graduation. Start with the most current one.
Dates (To–From) Position Name of Institution Responsibility
(indicate month)
Articles/Books/Unpublished Papers/Thesis/Dissertation**
Title of publication Subject Type*** Date
If you have ever traveled or lived outside Indonesia, please specify dates, countries and
purpose**
Dates Country Purpose
____________________ ___________________________
___________________________________________________
____________________ ___________________________
___________________________________________________
____________________ ___________________________
___________________________________________________
____________________ ___________________________
___________________________________________________
Please indicate if you have previously applied for a U.S. visa and the status of that
application
Dates Type of Visa Applied for Status of that Application
____________________ ___________________________
___________________________________________________
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FULBRIGHT-DIKTI PRELIMINARY APPLICATION FORM
____________________ ___________________________
___________________________________________________
Research Proposal
(for Senior Research Program applicants only)
This section is very IMPORTANT: As part of the evaluation of your application, you are required to attach a
three to five-page Research Proposal. (See below)
Research Proposal (for both Doctoral Dissertation Research and Senior Research
Program)
Project title:
___________________________________________________________________________________________________________________
This section is very IMPORTANT. Please write, between three to five pages, a clear and detailed
description of your proposed activity including the following items: (1) Background: When possible, place the
project in academic or professional context by referring to the major work by others on the topic. In some cases this can be
aided by use of a select bibliography.
(2) Objective: Define clearly the aims of the project. (3) Methodology: Describe the project and explain the approach and
methods you will follow. (4) Significance: Explain the significance of the project for the field, your own professional
development, and home country. (5) Others: (a) Indicate why residence in the United States is necessary for
accomplishment of the project.
(b) Explain how your project can be completed within the time period requested.
Declaration
•I hereby certify that the information I have provided on this application form and in any attached materials is
accurate and true to the best of my knowledge and belief, and I agree to notify DIKTI 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 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.
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FULBRIGHT-DIKTI PRELIMINARY APPLICATION FORM
•I have no objection to publicity about my selection for a Fulbright-DIKTI Scholarship.
Note:
*IELTS score of 5.5 is approximately equal to 525 on the TOEFL; 6.0 = 550; 6.5 = 575; 7.0 = 600
**Please attach additional pages if necessary.
***Articles, books, unpublished paper/ thesis/dissertation
The Fulbright-DIKTI scholarship program was launched in 2009 by the Ministry of National Education Directorate
General of Higher Education (DIKTI) in cooperation with The American-Indonesian Exchange Foundation (AMINEF)
to offer Higher Education Scholarships to permanent Indonesian faculty members of state and private
universities to pursue full time graduate study or conduct doctoral dissertation or post doctoral research
programs at U.S universities in any fields of study with the exception of medical sciences related to patient care
or medical training. Foreign medical doctors may be eligible to apply if they are engaged in observation and
research.
A correctly prepared application packet facilitates the review process and increases your
chance for an award. It is your responsility to ensure that the application is complete
before submitting it to the following address:
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