www.nesoindonesia.or.

id
ots@nesoindonesia.or.id
Jl. H. R . Rasuna Said Kav S-3
Jakarta 12950 – Indonesia
T. (+62) 21 5248 267

Orange Tulip Scholarship (OTS) Indonesia

Academic year 2019-2020
Application Form
(save with this format: Application Form_targeted university_your name)

1. PERSONAL INFORMATION

Full name Click here to enter text. ☐ Male ☐ Female

Address Click here to enter text.

City & postcode Click here to enter text. Click here to enter text.

E-mail Click here to enter text.

Mobile phone & telephone Click here to enter text. Click here to enter text.

Birthday (dd/mm/yyyy) Click here to enter text.

Birthplace Click here to enter text.

Nationality 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.

☐ I have been accepted by the eligible Dutch institution in one of the eligible
Current application
status study
programmes
Study programme: Click here to enter text.
Institution: Click here to enter text.

www.nesoindonesia.or.id/ots)
☐ No
☐ Yes (please specify below)

Institution Study programme

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

Are you also applying
to other institutions Click here to enter text. Click here to enter text.
under the Orange Tulip
Click here to enter text. Click here to enter text.
Scholarship?
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 2019-2020 Application Form

© 19/07/2017
www.nesoindonesia.or.id
ots@nesoindonesia.or.id
Jl. H. R . Rasuna Said Kav S-3
Jakarta 12950 – Indonesia
T. (+62) 21 5248 267

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

☐ 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
Click here to enter text.
education institution

City & country Click here to enter text. Click here to enter text.

Study programme Click here to enter text.

Level of degree (to be)
☐ High school ☐ Bachelor ☐ Master ☐ PhD
obtained
(Expected) month &
year of graduation Click here to enter text.
(mm/yyyy)

GPA
out of
☐ IELTS ☐ iBT
English exam score & (month+year): (month+year):
☐ I have not taken an exam yet
month + year taken Click here to enter Click here to enter
text. text.
GRE test result Month & year taken: Click here to enter
Click here to enter text.
(if applicable) text.
GMAT test result Month & year taken: Click here to enter
Click here to enter text.
(if applicable) 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 2019-2020 Application Form

© 19/07/2017
www.nesoindonesia.or.id
ots@nesoindonesia.or.id
Jl. H. R . Rasuna Said Kav S-3
Jakarta 12950 – Indonesia
T. (+62) 21 5248 267

Please specify other scholarships that you are applying to:

Click here to enter text.

7. CHECK REQUIRED DOCUMENTS

Please check the required documents of each scheme at www.nesoindonesia.or.id/ots

Please send the required documents to Nuffic Neso Indonesia (ONLY softcopy to ots@nesoindonesia.or.id)
before 1 April 2018 (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.

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 : Click here to enter text.

Date : Click here to enter text.

Name : Click here to enter text.

Signature : Click here to enter text.

Orange Tulip Scholarship Indonesia 2019-2020 Application Form

© 19/07/2017