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 2016-2017
Application Form
1. PERSONAL INFORMATION
Full name

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Address

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City & postcode

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E-mail

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Mobile phone & telephone

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Birthday (dd/mm/yyyy)

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Birthplace

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Nationality

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2.

Male

Female

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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?

Study programme

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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 2016-2017 Application Form

30/10/2015

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
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

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City & country

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Study programme

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Level of degree (to be)

obtained

High school

(Expected) month & year

of graduation (mm/yyyy)

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Bachelor

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Master

PhD

out of
GPA

English exam score &

month + year taken

IELTS
(month+year): Click
here to enter text.

GRE test result (if applicable)

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Month & year taken: Click here to enter

text.

GMAT test result (if

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Month & year taken: Click here to enter

text.

applicable)

iBT (month+year):
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text.

I have not taken an exam yet

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 2016-2017 Application Form

30/10/2015

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:

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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 (softcopy to ots@nesoindonesia.or.id AND hardcopy to
Menara Jamsostek 20th Floor, Jalan Gatot Subroto 38 Jakarta 12710 Indonesia) before 1 April 2015 (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

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Orange Tulip Scholarship Indonesia 2016-2017 Application Form

30/10/2015