APPLICATION INFORMATION
SHORT COURSE 2015
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 March 2015 and the result will be announced to the applicants at the latest by April 2015.
Failure to react to Neso’s 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)’ minimum score 5,5; (If required applicant should be able to provide NESO Indonesia the original test certificate). This requirement is waived if you have obtained a degree from an English-speaking country within two years since you are awarded by submitting a transcript and diploma from the institution attended.
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 2015
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 2015 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.
APPLICATION FORM
SHORT COURSE 2015
TO BE FILLED IN BY APPLICANT
Name :
Full time / Part time
Employer:
(Name of Institution)
City:
Province:
Employed Since: (dd/mmm/yyyy)
Applicant Position:
Position Held Since: (dd/mmm/yyyy)
APPLICATION FORM SHORT COURSE 2015
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 / (dd/mm/yyyy)
Marital Status
Single
Married Children
Yes
NoE-mail Address 1. 2.
Address
City: Province:
Telephone Home: Mobile:
Emergency Contact (or Next of Kin)
Relationship:
E-mail: Tel:
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 From: (dd/mm/yyyy) to (dd/mm/yyyy) Duration: months
Contact Person E-mail:
Total Tuition Fee EUR
Minimum TOEFL/IELTS
University or Institution Country:
Study Programme
Award Obtained
Bachelor
Other ……… Year of graduation: GPAb. Postgraduate Education or Training
Please enclose certified copies of relevant diplomas, degrees, certificates and transcripts.
University or Institution Country:
Study Programme From (dd/mm/yyyy) to (dd/mm/yyyy)
Award Obtained
Master
Other ……… Year of graduation GPA4. 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 (dd/mmm/yyyy)
Employed Since From: (dd/mmm/yyyy) To:(dd/mmm/yyyy)
Employment For Hours a week
Describe Your Current Duties And
Responsibilities
Address City: Province:
Phone: Fax:
E-mail: Website:
Brief description of Your Employer
5. MOTIVATION STATEMENT
The statement should be typewritten and composed only by the applicant him/herself.
No. Criteria Explanation
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 study programme will benefit how the chosen 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...)
Have you applied for StuNed Scholarship Programme before?
No
Yes, year………… Program: MA SC Tailor Made
Have you ever been awarded a
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:
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 short course 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 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 program/course for the entire period of the programme?
Yes
NoDo 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
NoWhich position will be offered to the candidate after succesful completion of
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. APPLICANT’S DECLARATION
