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www.nesoindonesia.or.id info@nesoindonesia.or.id Menara Jamsostek 20th Floor Jalan Gatot Subroto 38 Jakarta 12710 Indonesia T.

(+62) 21 52902172

Orange Tulip Scholarship (OTS) Indonesia Academic year 2014-2015 Application Form
1. PERSONAL INFORMATION
Full name Click here to enter text. Male Female

Address

Click here to enter text.

City & postcode E-mail Mobile phone & telephone Birthday (dd/mm/yyyy) Birthplace Nationality

Click here to enter text. Click here to enter text. Click here to enter text. Click here to enter text. Click here to enter text. Click here to enter text.

Click here to enter text.

Click here to enter text.

2.

STUDY PROGRAMME IN THE NETHERLANDS


I am currently applying to one of the eligible programmes Study programme: Click here to enter text. Institution: Click here to enter text.

Current application status

I have been accepted by the eligible Dutch institution in one of the eligible study programmes Study programme: Click here to enter text. Institution: Click here to enter text.
(See list of eligible programmes and participating institutions at www.nesoindonesia.or.id/ots)

No Yes (please specify below) Institution Are you also applying to other institutions under the Orange Tulip Scholarship? Click here to enter text. Click here to enter text. Click here to enter text. Click here to enter text. Study programme Click here to enter text. Click here to enter text. Click here to enter text. Click here to enter text.

You can apply to more than one OTS schemes. For each scheme, a separate OTS application form needs to be submitted.

Orange Tulip Scholarship Indonesia 2014-2015 Application Form 12/11/2013

www.nesoindonesia.or.id info@nesoindonesia.or.id Menara Jamsostek 20th Floor Jalan Gatot Subroto 38 Jakarta 12710 Indonesia T. (+62) 21 52902172

3. ADDITIONAL OTS INDONESIA SCHEMES


If you would like to be considered for additional schemes, please write the additional scheme(s) that you are interested in. IMPORTANT: Please regularly check the offered additional schemes and the requirements at www.nesoindonesia.or.id/ots/skematambahan Additional scheme 1: Click here to enter text. Additional scheme 2: Click here to enter text. Additional scheme 3: Click here to enter text.

4. ACADEMIC BACKGROUND
Name of last/current education institution City & country Study programme Level of degree (to be) obtained (Expected) month & year of graduation (mm/yyyy) GPA English exam taken GRE test result (if applicable) GMAT test result (if
applicable)

Click here to enter text. Click here to enter text. Click here to enter text. High school Click here to enter text. Bachelor Master PhD Click here to enter text.

out of IELTS: Click here to enter text. Click here to enter text. Click here to enter text. iBT: Click here to enter text. I have not taken an exam yet Month & year taken: Click here to enter text. Month & year taken: Click here to enter text.

5. WORKING EXPERIENCE
Current or last working experience (If applicable). Please include your curriculum vitae on a separate file

Company/ organization: Click here to enter text. Job position: Click here to enter text. Short job description (max. 2 lines): Click here to enter text.

Other working experience(s) (max. 2 lines): Click here to enter text.

6. FINANCING YOUR STUDIES


How do you plan to finance your studies at the Dutch higher education institutions (multiple answers possible)? My own savings Bank credit/loan Parents or family Scholarship(s) Employer Other: Click here to enter text.

Orange Tulip Scholarship Indonesia 2014-2015 Application Form 12/11/2013

www.nesoindonesia.or.id info@nesoindonesia.or.id Menara Jamsostek 20th Floor Jalan Gatot Subroto 38 Jakarta 12710 Indonesia T. (+62) 21 52902172

Please specify other scholarships that you are applying to: Click here to enter text.

7. CHECKLIST

Please send the following documents to Nuffic Neso Indonesia (softcopy to ots@nesoindonesia.or.id AND hardcopy to th Menara Jamsostek 20 Floor, Jalan Gatot Subroto 38 Jakarta 12710 Indonesia) before 1 April 2014 (unless the institution for which you are applying mentions a different deadline on the Orange Tulip Scholarship website). Incomplete forms and packages will not be taken into account. Completely filled out scholarship application form (one for each scheme you are applying for) Curriculum vitae (in English) Motivation letter (in English) Proof of admission (unconditional/conditional Letter of Acceptance) or proof of having started admission procedure at the eligible Dutch institution (e.g. e-mail from university, online application confirmation)
PLEASE NOTE THAT EACH ORANGE TULIP SCHOLARSHIP SPONSOR MAY REQUIRE ADDITIONAL DOCUMENTATION. PLEASE READ CAREFULLY THE INFORMATION ON THE NUFFIC NESO INDONESIA ORANGE TULIP SCHOLARSHIP WEBPAGE

All data will be treated strictly confidential by Nuffic Neso Indonesia and the selected Dutch higher education institutions, solely for the purpose of the Orange Tulip Scholarship Indonesia programme application.

I certify that the information I have provided in this form is true, complete and correct. Place Date Name Signature : Click here to enter text. : Click here to enter text. : Click here to enter text. : Click here to enter text.

Orange Tulip Scholarship Indonesia 2014-2015 Application Form 12/11/2013

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