www.nesoindonesia.or.

id
Menara Jamsostek 20th Floor, Jl. Gatot Subroto No. 38, Jakarta 12710 P +62 21 5290 2172 F +62 21 5290 2173

APPLICATION INFORMATION SHORT COURSE 2014

A. INSTRUCTIONS FOR THE APPLICANT:
Answer questions 1 through 8 clearly 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 the 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 selection will be held in April 2014 and the result will be announced to the applicants at the latest by end of May 2014. Failure to react to Nesos correspondence/e-mail within 3 working days can lead to cancellation of the scholarship. 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 of the 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 Dutch Higher Education Institution in the Netherlands for the course you are applying; Certificate copy of `TOEFL Internet-Based Test Examinee Score Report minimum 68 or `International English Language Testing System Test Report Form (IELTS Report Form) min imum score 5.5; (If required applicant should be able to provide NESO Indonesia the original test certificate) Curriculum vitae, see format on website www.nesoindonesia.or.id; Copy SK for government officials or kontrak kerja for others; Legalized copies of original diplomas and transcripts; Copy of KTP or copy of passport One recent photograph (3x4; colour)

The closing date is 1 March 2014 Applications received after the closing date and incomplete application will not be processed. Two complete sets of application form should be submitted. Completion in stages is not possible.

C. SELECTION PROCEDURE
March 2014 All applications are checked on their completeness. Incomplete applications will not be processed. Candidates who disqualify during this stage will receive a written notice. Based on the formal StuNed criteria a list of eligible candidates is composed for the final selection. This selection will result in a number of selected candidates and a ranked list of reserve candidates. If among the final selection some candidates refuse or are not able to receive the scholarship, candidates on the ranked reserve list will be awarded the scholarship. Selected candidates will be notified through a letter via e-mail, conveying extensive information about procedures to be followed-up, the Rules and Regulations of the StuNed Scholarship programme, a package with information about the Netherlands and information about the visa procedure.

May 2014

APPLICATION FORM SHORT COURSE 2014

TO BE FILLED IN BY APPLICANT
Please attach a recent photograph 3x4

Name :
Male Female
FOR OFFICIAL USE ONLY
Documents Application form Employer statement Applicant's declaration Admission letter IBT/IELTS Y N

E-mail 1 : E-mail 2 :

GPA:

S1 GPA MAX

S2 GPA Test date:

dd mm

CV SK

MAX
yy

Original diploma Original transcript KTP or Passport

IBT / IELTS:

Eligibility 2 years working exp.

Chosen Programme:

Full time / Part time Employer Statement SK

University in NL:

GPA IELTS/IBT

Duration:

months

Study Abroad Admission Letter Chosen Programme Tuition Fee StuNed/NFP awardee

Employer: (Name of Institution) City: Province: Employed Since: Applicant Position: (dd/mmm/yyyy)

Selection 2014 EKN 2014 GMF 2014 JOJ 2014 MIB Total score

Score

Final Result

Y/N

Position Held Since:

(dd/mmm/yyyy)

Scholarship Award

APPLICATION FORM SHORT COURSE 2014

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 passport ! Name Place / Date of Birth Marital Status E-mail Address Address City: Telephone Emergency Contact (or Next of Kin) Home: Province: Mobile: Relationship: E-mail: Tel:

/ (dd/mm/yyyy)

Single
1.

Married

Children 2.

Yes No

2. DESIRED COURSE FOR WHICH YOU HAVE BEEN ADMITTED

Please enclose the admission letter from the University or Institution. University Name Study Programme Program Period Contact Person Total Tuition Fee Minimum TOEFL/IELTS EUR From: (dd/mm/yyyy) to (dd/mm/yyyy) E-mail: Duration: months

3. EDUCATIONAL BACKGROUND
a. Undergraduate Education Please enclose certified copies of relevant diplomas and transcripts University or Institution Study Programme Award Obtained Country:

Bachelor Other Year of graduation:

GPA

b. Postgraduate Education or Training Please enclose certified copies of relevant diplomas, degrees, certificates and transcripts . University or Institution Study Programme Award Obtained Country: From (dd/mm/yyyy) to (dd/mm/yyyy)

Master

Other

Year of graduation

GPA

4. ENGLISH PROFICIENCY
Please enclose copy of your Test Result. Test Name

IBT TOEFL

IELTS

Test Score ..............

Test Date:

4. PRESENT EMPLOYMENT Employer Department/Directorate Present Position This Position Held Since Employed Since Employment For Describe Your Current Duties And Responsibilities (dd/mmm/yyyy) From: (dd/mmm/yyyy) Hours a week To: (dd/mmm/yyyy)

City: Address Phone: E-mail: Brief description of Your Employer

Province: Fax: Website:

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 study programme to your personal and career development

B.

Explain in 100 words the relevance of the chosen study programme to the current development of your organization (long term development plan) and the sector you work in.

C.

Describe in 100 words how the chosen study programme will benefit Indonesia in general.

6. MISCELLANEOUS
How did you find out about the StuNed Scholarship Programme for the very first time?

(TICK ONLY ONE ITEM) Nuffic Neso Indonesia website Nuffic Neso Indonesia 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 Neso Indonesia 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 Dutch Higher Education Institution website Friends Your institution Nuffic Neso Indonesia office Others (please indicate................................................................) No Yes, year Program: MA

Have you applied for StuNed Scholarship Programme before? Have you ever been awarded a scholarship? 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?

SC Tailor Made

Yes

No

7. STATEMENT BY THE EMPLOYER I, the undersigned, being authorised to supply the following particulars hereby certifies that: Name of Applicant: Employed Since: (dd/mm/yyyy) Department/Directorate: Current Position: for hours a week Position Held Since: (dd/mm/yyyy) And is applying for a StuNed scholarship to follow a master programme in The Netherlands in the field of / name of the study programme:

Dutch Higher Education Institution (University) in the Netherlands :

Please explain fully why the short course is important to your organisation (and to the applicants 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 program/course for the entire period of the programme? Yes No 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? Yes No Which position will be offered to the candidate after succesful completion of her/his study?

Department:

I certify that all my answers are true, complete and correct, and that if the candidate is awarded a StuNed scholarship, my organization will fully support and comply with all the formal obligations this entails. Name, complete address & contact number (of organization) : Name (of contact person) and Position*: E-mail address: Date: Place: Signature and Official Stamp (Obligatory): (please sign on materai (obligatory)

Acknowledgement from Human Resource Division

Name and Signature (Affix Official Stamp)

Date:

*) the lowest level of employer authorisation should be at least echelon 2 command or the equivalent level in the Ministry or Institution. Failure upon providing sufficient authorisation will lead to disqualification of application.

8. APPLICANTS DECLARATION

I completely understand the conditions under which the scholarship is offered, and if I am awarded a StuNed scholarship I agree: 1. 2. 3. 4. 5. 6. 7. to comply with all the formal obligations mentioned in the Rules & Regulations of StuNed; to return to my home country immediately after the programme has ended; to be available for the entire period of the study programme and be able to take part in the entire programme; to give permission to enter my personal data in a database which may be used at Nuffic Neso Indonesias discretion to provide information for non- commercial purposes; to abide by the rules and regulations governing the student visa and stay permit; to fill in online end- of- course questionnaire; to act in such a manner that will not bring disrepute or cause any formal damage to any party involved in the programme including the host institution, the image of Indonesian students in the Netherlands, Nuffic Neso Indonesia and accept to be called back to Indonesia without any formal appeal in case I breach this promise; to participate in activities organised in relation to the StuNed scholarship whenever required; not to engage in employment in the Netherlands other than the allowed maximum of ten hours a week, and to inform and update Neso of any details of such employment if any; not to hold another scholarship that would give any overlapping benefit without Nuff ic Neso Indonesias written approval.

8. 9. 10.

Furthermore: 11. I commit to inform Nuffic Neso Indonesia immediately of any circumstances (serious illness, incident, incapacity, pregnancy, arrest, exclusion, death of relatives, problems at home, etc.) that occur during my study and that might affect the progress of my course. I realise and consent that Nuffic Neso Indonesia may terminate the scholarship; 12. I fully understand that if I am awarded a StuNed scholarship, it may be subsequently withdrawn if I fail to make adequate progress, or for other sufficient cause determined by the Government of the Netherlands or the institution at which I am studying; 13. If reports from the host institutions give reason to doubt a successful continuation of the study, the scholarship may be terminated with immediate effect. I certify that all my answers are true, complete and correct. Date Name Place Signature : : : : (please sign on materai (obligatory)

THE ORIGINAL APPLICATION FORM AND ITS ANNEXES SHOULD BE SENT TO: Nuffic Neso Indonesia Menara Jamsostek 20th Floor Jalan Jend. Gatot Subroto No.38 Jakarta 12710