Index of /ProdukHukum/kehutanan

DEPARTEMEN

KEHUTANAN

SEKRETARIAT

JENDERAL

PUSAT KERJASAMA LUAR NEGERI

Alamat : Gedung Manggala Wanabakti, Jalan Gatot Subroto Blok VII Lt. 4 - Jakarta 10270 Telephon : (021) 5701114

-

5730165 Telex 65591 Dephut lA

Faximile : (021) 5720210

Nomor Lampiran Hal

:

5/i7

jKLN-3j2010

'It Januari2010

: 1 (satu) berkas

: Tawaran beasiswa Pemerintah New

Zealandj NZDS

Kepada Yth.

KepalaPusat Pendidikandan Pelatihan Kehutanan

di-Bogor

Menunjuk surat

Sekretariat

Negara

RI

No.B-26950jSetnegjSetmenj

KTLNj12j2009tanggal 30 Desember 2009 perihal tersebut diatas (copy terlampir),

dengan

hormat kami beritahukan bahwa Pemerintah New ZealandjNZAID

menawarkan beasiswa dalam rangka

New Zealand Development Scholarship

(NZDS)

Tahun Akademik2011.

Sehubungan dengan hal itu, kami mengharapkan bantuan Saudara untuk

menyampaikan informasi beasiswa tersebut kepada PNS Departemen Kehutanan

yang berminat danjatau untuk ditampilkanpada

website

Dephut.

/

Pegawai yang berminat dapat mengisi formulir

Expression of Interest

dan

disyahkan ole-hInstansi yang bersangkutan, dan dapat dikirim ke Kedutaan Besar

New

Zealand paling lambat tanggal 15 Pebruari 2010 kepada:

-;:::--Mr. KirkYates, First Secretary and NZAIDManager,

Kedutaan Besar

New

Zealand, Sentral Senayan II, Lantai 10

JI. Asia Afrika NO.8 Gelora Bung Kamo Jakarta Pusat 1.0270

Demikianatas perhatian dan kerjasamanya, kami ucapkan terima kasih.

Tembusan Kepada Yth. :

~

1. Sekretaris Jenderal

---2. Para Sekretaris DitjenjBadanlingkupDep. Kehutanan

3.

Para

KepalaBirojPusatlingkupSekretariatJenderalDep.Kehutanan

4. DirekturPerencanaan Kawasan Hutan up.

KepalaSub DirektoratStatistik dan Jaringan KomunikasiData

Kehutanan

SEKRETARIAT NEGARA

REPUBLIK INDONESIA

Nomor

Sifat

Lampiran :

H a I

B-

j.(, sso /Setneg/Setmen/KTLN/12/2009 Segera

Jakarta, -p Desember

2009

Tawaran Beasiwa Pemerintah New Zealand/

NZDS

Yth.

( Daftar

terlampir

)

di

Jakarta

Dengan hormat kami sampaikan tawaran beasiswa Pemerintah New

Zealand/-NZAID dalam rangka

New Zealand Development Scholarships

(NZDS) untuk mengikuti

pendidikan program pasca-sarjana (program Master dan Doktor) dalam bidang-bidang yang

menjadi prioritas pembangunan Indonesia pada universitas-universitas di New Zealand

untuk tahun akademik 2011.

Sehubungandengan hal tersebut,diharapkaninstansiSaudaradapat

menyam-paikan calon-calonyang memenuhipersyaratankepada

Mr. Kirk. Yates, First Secretary

and NZAID Manager, Kedutaan Besar New Zealand, Sentral Senayan 1/,Lantai 10 Jln.

Asia Afrika No.

8

Ge/ora Bung Karno Jakarta Pusat 10270 Telp.

2995

5800,

selambat-lambatn

a

tan

al

15

Februari 2010 den an

mem

isi formulir Ex ression

of

Interest

yanq disyahkan oleh Instansi Saudara (ranqkap

3~.

Bagi para calon yang memenuhi persyaratan dan dinyatakan lulus seleksi awal

akan diundang untuk mengikuti tes bahasa Inggris dan wawancara dengan ketentuan harus

melengkapi dan menyerahkan dokumen-dokumen pendukung lainnya kepada Kedubes New

Zealand

selambat-Iambatnva

tanqqal16 April 2010

berupa:

a. Application Form

New Zealand Development Scholarship

(NZDS) yang telah

disyah-kan oleh Instansi Saudara (rangkap 3);

b. Salinan Ijazah asli dan terjemahannya dalam bahasa Inggris dan dilegalisir (rangkap 3);

c. Salinan transkrip akademis dan terjemahannya dalam bahasa Inggris dan dilegalisir

(rangkap 3);

d. Fotokopi hasil tes kemampuan bahasa Inggris sebagaimana tersebut pada angka 2 di

atas;

e. Salinan surat menyurat dengan universitas di New ~ealand, jika ada.

Untuk lebih jelasnya ...

BB/302

SEKRETARIAT NEGARA

REPUBLIK INDONESIA

Nomor

Sifat

Lampiran :

H a I

B-

j.(, sso /Setneg/Setmen/KTLN/12/2009 Segera

Jakarta, -p Desember

2009

Tawaran Beasiwa Pemerintah New Zealand/

NZDS

Yth.

( Daftar

terlampir

)

di

Jakarta

Dengan hormat kami sampaikan tawaran beasiswa Pemerintah New

Zealand/-NZAID dalam rangka

New Zealand Development Scholarships

(NZDS) untuk mengikuti

pendidikan program pasca-sarjana (program Master dan Doktor) dalam bidang-bidang yang

menjadi prioritas pembangunan Indonesia pada universitas-universitas di New Zealand

untuk tahun akademik 2011.

Sehubungandengan hal tersebut,diharapkaninstansiSaudaradapat

menyam-paikan calon-calonyang memenuhipersyaratankepada

Mr. Kirk. Yates, First Secretary

and NZAID Manager, Kedutaan Besar New Zealand, Sentral Senayan 1/,Lantai 10 Jln.

Asia Afrika No.

8

Ge/ora Bung Karno Jakarta Pusat 10270 Telp.

2995

5800,

selambat-lambatn

a

tan

al

15

Februari 2010 den an

mem

isi formulir Ex ression

of

Interest

yanq disyahkan oleh Instansi Saudara (ranqkap

3~.

Bagi para calon yang memenuhi persyaratan dan dinyatakan lulus seleksi awal

akan diundang untuk mengikuti tes bahasa Inggris dan wawancara dengan ketentuan harus

melengkapi dan menyerahkan dokumen-dokumen pendukung lainnya kepada Kedubes New

Zealand

selambat-Iambatnva

tanqqal16 April 2010

berupa:

a. Application Form

New Zealand Development Scholarship

(NZDS) yang telah

disyah-kan oleh Instansi Saudara (rangkap 3);

b. Salinan Ijazah asli dan terjemahannya dalam bahasa Inggris dan dilegalisir (rangkap 3);

c. Salinan transkrip akademis dan terjemahannya dalam bahasa Inggris dan dilegalisir

(rangkap 3);

d. Fotokopi hasil tes kemampuan bahasa Inggris sebagaimana tersebut pada angka 2 di

atas;

e. Salinan surat menyurat dengan universitas di New ~ealand, jika ada.

Untuk lebih jelasnya ...

BB/302

SEKRETARIAT NEGARA

REPUBLTK INDONESIA

-

2

-Untuk lebih jelasnyaO,kami lampirkan pula informasi persyaratan-persyaratan

calon untuk mengikuti program beasiswa tersebut di atas sebagaimana tercantum dalam

Guidelines/NZAID Scholarships

Information 2011

atau dapat menghubungi

Kedubes

New Zealand (Sdri. Indirawati. Te/p. 29955800/

Email: ira.indirawatiCCD.nzaid.Qovt.nz).

Atas

perhatian Saudara, kami mengucapkan terima kasih.

BB/302

SEKRETARIAT NEGARA

REPUBLIK INDONESIA

Kepada Yth.:

~8.

9.

1. Sekretaris Utama

Badan Nasional Penanggulangan Bencana

2. Sekretaris Lembaga Administrasi Negara

3. Sekretaris Jenderal Kementerian Pendidikan Nasional

u.p. Kepala Biro Perencanaan dan Kerja Sama Luar Negeri

4. Sekretaris Jenderal Kementerian Pertanian

u.p. Kepala Biro Kerjasama Luar Negeri

5. Sekretaris Jenderal Kementerian Pertahanan

u..p.Kepala Biro Kerjasama Luar Negeri

6. Sekretaris Jenderal Kementerian Oalam Negeri

u.p. Kepala Pusat Administrasi Kerjasama Luar Negeri

7. Sekretaris Jenderal Kementerian Kelautan dan Perikanan

u.p. Kepala Biro Perencanaan

Sekretaris Jenderal Kementerian Kehutanan

u.p. Kepala Pusat Kerjasama Luar Negeri

Sekretaris Jenderal Kementerian Hukum dan Hak Asasi Manusia

U.p.Kepala Biro Kepegawaian

10. Sekretaris Jenderal Kementerian Pekerjaan Umum

u.p. Kepala

Biro Perencanaandan KerjasamaLuar Negeri

11. SekretarisNCB-Interpollndonesia

MarkasBesarKepolisianRepublikIndonesia

12. KepalaPusat Pendidikandan Latihan,KementerianLuar Negeri

13. KepalaPusatPembinaandan Pendidikandan PelatihanPerencana,Bappenas

14. KepalaPusatPendidikandan Latihan,SekretariatNegara

15. Kepala Biro Perencanaandan KerjasamaLuar Negeri, KementerianNegara

Ling-kunganHidup

16. Kepala Biro Umum, Kementerian.Negara PendayagunaanAparatur Negara dan

Reformasi Birokrasi

---BB/302

INDONESIA

~

nzaid

. ~ . '! . . - . . - ',: -.'t' I , "

~ZAID' SCHOLA~StllrSllli1Cluiring

_.

minds

_.

c'reating

_{. .}

futures

Informationfor intake commencing 2011

Country strategy

Indonesia is NZAID's largest bilateral development programme in South East Asia. New Zealand has carefully reconsidered its approach and is now finalizing its 10-year country programme strategy (2009-2019) that identifies an overarching goal of 'Economic development through improved governance for a peaceful, just and prosperous Indonesia'. This goal would be pursued through three integrated priority areas: rural economic development, education for economic opportunity and peace to underpin development. Scholarships applications will need to align to this new direction and in particular to the three new priority areas.

Type, level and numberof scholarships

NZDS-Public and NZDS-Open scholarships are available to public servants, lecturers from academic institutions, and also to members of non-government organisations, private sector and other agencies, (preferably organisations and agencies that are working in partnership with NZAID). The NZDS scholarships are for postgraduate study only, primarily for Masters level qualifications, though a small number of scholarships for Doctorate (PhD) level by research are also available. Applications for PhD level need to demonstrate particularly strong developmental relevance.

There are two categories of New Zealand Development Scholarships (NZDS):

The NZDS-Public category is primarily intended to strengthen public sector capacity. Applicants from the public sector may apply to the New Zealand Embassy in Jakarta and shortlisted candidates are endorsed by the Government of Indonesia. Up to eleven (11) NZDS Public scholarships are available for each academic year.

The NZDS-Open category is available to individuals who independently apply for a scholarship. Applicants apply directly to a participating New Zealand education institution (see Annex 1). Up to four (4) NZDS Open scholarships are available for each academic year. In the event of insufficient NZDS-Public applications that meet the criteria, a correspondingly greater number of NZDS-Open places will be made available.

Priority sectors

New Zealand Development Scholarships will be awarded in areas recognised by the Government of Indonesia (BAPPENAS/SEKNEG).

KeyPriority sectors

Rural economic development

-

inareas that aligned to improvements in rural livelihoods. Education for economic opportunity

-

in areas that aligned to the development of vocational education opportunities.

..'

Peace to underpin development

-

in areas that aligned to development and monitoring of

policies or frameworks that promote cultural tolerance or encourage interfaith dialogue.

2

Secondary Priority sectors

Governance; Human Rights; Environment; and Disaster Risk Reduction/Mitigation.

Applicants seeking study in subject areasiwhich aim to strengthen other developmental aspects related to the above areas but are not specified here may also be considered.

Eligibility criteria

Applicants must meet the following NZDS eligibility criteria before their applications will be consideredagainstthe selectioncriteria.Applicantsmust:

.

be a citizen of Indonesia(Le. permanentresidentsare not eligible to apply);

.

be residing in Indonesiafor at least two years prior to application;

. not have citizenshipor permanentresidencestatus of New Zealand or Australia or another country;

. not be married or engagedto be married to a person who holds, or who is eligible to hold, citizenshipor permanentresidencestatus of New Zealand, Australia or another developed country1;

. be no more than 40 years of age at the time of application;

. be applying to commence a new qualification and not seeking funding for one already commencedin New Zealand or anothercountry2;

. not have completed. or nearly completed, a qualification at a similar level (i.e. applicants must apply for a higher' level qualification than any previously attained), unless strong developmentalrelevanceis demonstrated;

. hold a recognised undergraduatedegree if applyingfor a Masters Degree, or a recognised Masters Degree if applying for a PhD. The applicantmust have a GPA of at least 3.0 out of 4.0 or equivalentfor their highestqualificationattainedto date. If a different grading system was used, the applicantmust submita certifiedtranslatedexplanationof the grade;

.

have academic backgroundthat is relevant to the field of study proposed for study in New Zealand and be able to clearly demonstrate the developmental relevance and applicability of their proposed study programme to the human resource development training needs of their country/institution;

. have been working in their home country, for at least two years prior to application, includingsince completionof their highesttertiaryqualificationgainedto date;

. be able to clearly demonstrate their links and commitment to Indonesia (e.g. services to their community,ability to influencechange in a key developmentsector etc), supportedby the statementsfrom their referees.The proposedstudy programmemust be relevantto:

.

recent paid and/or unpaid (volunteer)work experiences; · the training needs of the employingorganisation;and

. identifiedemploymentopportunitiesupon completionof their study.

. be able to take up the scholarshipin the academicyear for which it is offered;

. satisfy the admission requirementsof the New Zealand education institution at which the qualification is to be undertaken, including English language criteria (IELTS score at the minimumof6.5);

.

satisfyall the admission requirementsof New ZealandImmigration.

IA developedcountryis definedas a countrynot includedon the OECD'sDevelopmentAssistance Committee'slist of

aid recipients.

1NZAIDwillnot fund any stud&ntsto continuea qualificationthey have commencedoutside theirhome country.With prior agreement of the partner government, NZAIDwillconsider funding qualifications being studied Inthe home country by self-sponsored, part-time students on a case-by-case basis.

Applicants cannot:

.

be studying full-time at post-secondary le~el;

. be transferring from another tertiary scholarship (either in New Zealand or in another country) to a NZDS;

. hold, or have held, a New Zealand/Australian Government scholarship or other scholarships in the 24 months preceding the scholarship start date; or

. have been terminated from a New Zealand/Australian Government scholarship or other scholarships previously.

Applicants are expected to continue residing in Indonesia during the NZDS application and selection process. If offered a NZDS. candidates must:

. read carefully the letter of NZDS offer and sign the declaration in the NZDS offer indicating their acceptance of the award for the specified study programme, length of course and institution, as well as their ability to meet the timeframe proposed (including any English language training in Indonesia and/or in New Zealand), together with written endorsement from their employer;

. be able to satisfy Immigration New Zealand requirements (i.e. medical checks and police clearance/character checks, etc) and obtain the appropriate passport, student visa, all other documents required for entry to New Zealand;

. not have applied for New Zealand or Australian permanent residency and not seek or apply for New Zealand or Australian permanent residency or a work permit while on scholarship;

. not hold another scholarship during the period of the NZDS;

. travel to New Zealand alone and pass preliminary academic preparatory, English language or bridging programmes before being joined by any dependant family. NZAID recommends that all students settle into their academic study before their family joins them in New Zealand;

.

agree in writing that they will return to Indonesia upon completion of their scholarship for a minimum period of two years in order to contribute to their country's social or economic development before applying for other opportunities/scholarship abroad; and

.

agree to ,meet any other requirements that may be set by the New Zealand Embassy or Government of Indonesia.

Indonesia specific criteria

Top priority:Applicationsunder both NZAID Public and NZDS open categoriesfrom eligible individualsworkingand living'in easternIndonesia(particularlyfrom NTB. NTT, Maluku, Papua and West Papua)will be prioritisedduringthe selectionprocess.The applicantsmust be able to demonstratea strongcommitmentto the de.,;telopmentof the provincewhere they currently live in.

2ndpriority:NZAIDwill, as a lesserpriority,'considerapplicationsunder both NZDS-Publicand NZDS-Openfrom: DEPLU;BAPPENAS;Ministryof NationalEducation;Ministry of Agriculture, governmentand researchinstitution involved in Indonesia's managementof natural disaster particularly in planning and disaster preparedness; government institutions involved in environmentand conservation(Le. Ministry of Forestry, Ministry of Marine Resources and Fisheries, Ministry of Environment); Ministry of Defence;' Indonesia National Police; and academicstaff of nationaluniversitiesor other relevantpublic institutionsor agenciesthat are workingin partnershipwith NZAID.

3rd priority: Consideration will be given, as a third priority under NZDS-Open, to applicants who

do not qualify/meet the above two priorities, but applying for study in the priority sectors.

4

NZDS-Public selection process

Candidates of NZDS-Public will be selected by a committee consisting of representatives of the New Zealand Embassy in Jakarta.

Selection will be made against the above criteria and based on the principles of merit and equity. Selection will be made in several stag~s:

· Expressions of Interest (EOI) will be called for and assessed by the Embassy against the criteria set out in this information sheet. Deadline to submit the EOI is 15 February 2010.

· The most promising candidates will be identified and asked to complete a full NZDS application form. At this stage, applicants should provide full supporting documentation, including official endorsement from the applicant's employer. Applications must be signed and witnessed in front of a public notary, or an officer of the New Zealand Embassy.

Deadline to submit the application form is 16April 2010.

· Following an as~essment of the applications, selected candidates will be required to sit an additional IELTS test and attend an interview in Jakarta. NZDS-Public applicants must have a minimum overall IEL TS score of 5.5 or higher, with no band below 5.0,to be shortlisted.

· On the basis of these test results and interviews, a shortlist will be determined and forwarded to the State Secretariat RI for endorsement. Following endorsement, applications are sent to NZAID in New Zealand for placement at the appropriate New Zealand institutions.

The State Secretariat will continue to act as the Nominating Authority and contact point for NZAID and the nominating agencies of individual students for communications on placement, academic progress, course change or extension, deferral requests and terminations.

Applicants of NZDS-Public will be notified by the New Zealand Embassy regarding the success of their applications.

NZDS-Openapplication and selection process

NZDS-Opencandidates apply directly to one of the participating New Zealand education institutions (see Annex 1), after ensuringthat they meet the eligibilitycriteria.

The education institution distributes and receives NZDS-Open application forms. Applicants must ensure that the institution receives the completed NZDS application form (including all supportingdocumentation)before the institution'sclosing date (also in Annex 1). Applicantsare advised to send back the applicationswell before the closing date as the institutionmay require further informationor documentation.

The institution assesses the candidate's applicationfor admissionto the institution,and checks it against the NZDS eligibility criteria. The institution sends the complete applications of candidateswith unconditionaloffers of place, to NZAID's ScholarshipsUnit in Wellington, New Zealand.

All applications must be completed in English, with certified true copies of official English translations (where the original document is not in English) attached to the NZDS application form. Applicationswith incompletesupportingdocumentswill not be processed.

NZAID considers all eligible applications against the selection criteria above and advises the institutions of the outcome of the NZDS selection round by late September. This selection process may include shortlistedapplicantsbeing interviewedby NZAIDin Jakarta.

Applicants of NZDS-Open will be notified by their selected institution of the success of their applicationand what they should do next.

Government ofIndonesia expectations

-

NZDS Public and Op.an

The Governmentof Indonesiaand the New Zealand Governmentexpectall NZAID awardeesto complete their studies successfully. Awardees, upon cpmpletion of study, must immediately return to Indonesiaand to the employerthat nominatedhim/her.The individualmust send their

5

study report to the State Secretariat within 30 days. A copy of this report should be given to the New Zealand Embassy.

Within six months of return to Indonesia, awardees should share their knowledge gained with their colleagues. Possibilities might include giving a presentation or holding a workshop/seminar programme. A copy of the report of this programme should be sent to the New Zealand Embassy, Jakarta, and the State Secretariat.

By regulation of the Government of Indonesia, study awardees that are public servants/government officials must work for the Government for two years for each year of their study and for at least three years. Violation may result in the scholarship awardees being required to refund to the Government of Indonesia the full cost of the scholarship, plus100%.

Additional information

-

NZDS Public and Open

The purpose of the NZDS scheme is for scholarship holders to gain knowledge and skills in specific subject areas that will assist in the development of their home country by contributing to identified human resource development training needs. It is a pre-condition of accepting a New Zealand Development Scholarship that scholarship holders return to their home country to take up a position that utilises their study for a minimum period of two years.

Where a student's study programme is 18 months or longer, and the student has at least 12 months remaining of their study programme to complete, the student may be joined by their spouse/partner and dependant children at a higher rate of stipend. NZAID may fund the airfares to New Zealand for a student's spouse/partner and up to two dependant children. Eligibility

criteria apply.

Information on NZDS allowances and entitlements, and conditions of the NZDS scholarship, is provided on the scholarshipspages of NZAID's website: www.nzaid.govt.nzIscholarshipslnzds.html

Female applicants are strongly encouraged to apply as the New Zealand Government attempts to ensure gender equity among scholarship holders. NZAID will also consider such factors as good character, accuracy of answers, positive study attitude and motivation to succeed in the selection proc~ss.

Note: NZAID has the right to make a final decision on the offering of NZAID scholarships. NZAID has the right to amend terms and conditions of NZAID scholarships. Amendments will be posted on the NZAID website (www.nzaid.Qovt.nzlscholarshiDs).

Address for further information

Development Programme Administrator

NZAID

New Zealand Embassy

Sentral SenayanII, 10thFloor JI. Asia Afrika NO.8 Jakarta10270

INDONESIA

Tel: (+62-21) 29955800

Email address:ira.indirawati@nzaid.Qovt.nz

6

Annex 1: Contact details for New Zealand institutions and closing dates

New Zealand Developmer.t Scholarships applicants in the Open category apply directly to the

NewZealand

educationinstitutionwherethey wishto study.

New Zealand institution Universityof Otago

Contact details www.otago.ac.nz

international.admissions@otago.ac.nz

Closing date 30 April2010

Massey University www.massey.ac.nz

international@massey.ac.nz

1 May 2010

University of Waikato www.waikato.ac.nz int.centre@waikato.ac.nz

31 May 2010

Victoria University of Wellington (VUW)

www.victoria.ac.nz VUW-NZAID@vuw.ac.nz

15 May2010

(1 May2010for PhDs)

University of Canterbury www.canterbury.ac.nz

international@canterbury.ac.nz

1 May2010.

AUT University www.autinternational.info international.centre@aut.ac.nz

30 May2010

Lincoln University www.lincoln.ac.nz

international@lincoln.ac.nz

31 May 2010

University of Auckland www.auckland.ac.nz

int-questions@auckland.ac.nz

1 May 2010

Unitec www.unitec.ac.nz

international@unitec.ac.nz

18 June 2010

~

nzaid

New Zealand Development ~cholarships

-

Public Scheme

EXPRESSIONOF INTERESTFORM

For intake commencing 2011

New Zealand Development Scholarships (NZDS) are offered annually by New Zealand Government to Indonesian citizens for postgraduate study in New Zealand. Priority sectors for intake 2011 are: rural economic development,education for economic opportunity,peace to

underpin development. We will also consider secondary priority sectors which are: governance, human rights, el')vironment and disaster risk reduction/mitigation. NZDS are predominantly at Masters' level, but a small number of PhD awards are available. The scholarship provides for the cost of travel, tuition, medical insurance and modest living allowances. Applicants must meet eligibility criteria (including academic background and English language ability) and receive Government of Indonesia endorsement for their application. Please find full terms and conditions of the NZDS in2011 NZDS Information Sheet.

PERSONAL INFORMATION

0047375 _Page1

.

o

Which institution is nominating you?

o Fullnameas in passport:

o

Gender

-

o

Place and date of Birth

0 Female _{(Place) (Day) (Month) (Year)}

0 Male _{o What citizenship do you hold:} o Contact Details:

Address

Telephone (work): Hand phone :

Telephone (home) : Email:

Facsimile:

o

List spouse/partner and any children under 19 years you plan to bring to New Zealand:

Name _{Age Relationship}

(You will be requiredtoundertakeamedical check prior totravellingtoNew Zealand)

No

If yes, please provide brief details of support required:

Yes

o How did youfind out about the NZDS?

STUDY AND WORK INFORMATION

o I Have you received an NZAID or NZODA study award, or any other scholarships from AUSAID, USA or other donor before?

o No 0 Yes

If yes, please give details of: Award:

Year received:

o I What is the highest qualification you have completed?(DONOTsendcopiesof your transcripts-yet)

o A BachelorsDegree o A PostgraduateDiploma o A MastersDegree

Name of qualification GPA Score:

Out of

Subjects or specific areas of study

Year qualification was completed Name of institution

City and country of institution

o

I What

is your current job?

o I Job supervisor's name:

.

Position/job title

Department

Organisation

Telephone number Fax number

Email

o

I How long have you been working In this job?

Years Months

o IWill you return to this job after your study?

DYes 0 No

o IBriefly describe your work history (Including the work you did before this job) outlining:

.

positions held

.

area/s of work

.

duties/tasks performed

.

responsibilities

-o I

What skills or qualifications did you gain from your previous and current jobs?

ENGLISH LANGUAGE COMPETENCY

STUDY AWARD FOR TERTIARY STUDY IN NEW ZEALAND

o

Whatis the maximum length of time you have for study in NewZealand?

(Please include time for English language study and/or bridging programme if required)

0047375 Page4

o

Have you completed an International English Language (IELT) or TOEFL test?

DYes oNo _{o Not available in my area}

o If Yes, give the name, date and score of your English test

Name of test Date Score

Band scores: _{Listening Speaking Reading Writing}

Test of WrittenEnglish(TWE)for TOEFL:

o

If No, have you studied English as a subject at school or at tertiary level?

o No

DYes

Level

of study:

Lengthof study(years)

o

What is the level of your listening ability In English? Tick the box that is rightfor you

01 02

o 3

04

o 5

Not good Very good

o

What is the level of your speaking ability in English? Tick the box that is rightfor you

01 02 03 04 05

-Not good Very good

o

What Is the level of your reading ability In English? Tick the box that is right for you

01 02 03 04

o 5

Not good Very good

o What is the level of your writing ability in English? Tick the box that is right for you

01 02 03 04 o 5

Not good Very good

o Do you think you need to study English for academic purposes before you begin your studies?

o What level of qualification do you wish to study? Tick the box from the list:

o

Postgraduate Diploma

o

Masters Degree

o

Doctor ofPhilosophy (PhD)

o

Describe what you want to study and the skills you want to gain from your study in

NewZealand:

o Explainbrieflyhow your proposed study and skill is in line with NZDS'priority

sectors for intake 2011:

o Describe how your proposed study and skill willbenefit to the development of the

district or province where you are living,or to Indonesia in general:

-o

Explain how your employing organisation will benefit from your proposed study.

.

o

Tickthe area of work that is most like the work you want to do in the future, when you

have completed your study:

ENVIRONMENTAL &

RESOURCE MANAGEMENT _ Agriculture

_ Agriculture Engineering _ Conservation

_ Earth Science _ Ecology

_ Environmental Science _ Farm Management &v

Economics

EDUCATION

_ Early Child Education _ Education (General) _ Education Admin & Mgmt _ Primary Teaching

_ Secondary &Tertiary Teaching

_ Special Education Teaching

_ Subject Teaching

ENGINEERING

_ Agriculture Engineering _ Marine Engineering _ Natural Resource

Engineering

LAW

_ Environmental Law _ International Law _ Human Rights Law

ADMINISTRATION/BUSINESS _ Administration& Government _ Economics

_ Human Resource Management _ Management

_ Management Sciences

_ Public Policy & Planning

_ Fisheries

_ Forestry

_ Geology

_ Horticulture

_ LandPlanning

_ LandSurveying

_ Parks &Recreation

_ RegionalResource &

Planning

_ Resource Management

o

Writeyour first and second choices of course of study using the list above as a guide:

Firstchoice:

Second choice: SOCIAL SCIENCES/ HUMANITIES

_ DevelopmentPlanning

_ Psychology

_ SocialPolicy

_ Sociology

_ WomenStudies

_ Peace Studies

o

Please state research area/subject that you would like to study:

o State briefly any research or publication you have completed:

Research topic

Date

Titleof publicationsor unpublishedreports

Date

0047375

.

o

Give details of one person under whose guidance you have studied who can act as a

referee for you:

Name:

Occupation:

Address:

Telephone:

Email:

Facsimile:

APPLICANT DECLARATION

I do solemnlyand sincerelydeclare that

o I have read the NZDS guidelines and understand the terms and conditions of the scholarship I am applying for.

o

The informationI have providedabove is correctand I acknowledge

that by givingincomplete or falseinformationon this form NZAIDmaywithdrawthe scholarship.

Signature of applicant

Date: