KEMENTERIAN PENDIDIKAN NASIONAL

DIREKTORAT JENDERAL
PENDIDIKAN TINGGI
Jl. Jenderal sudirman Pintu

Senayan Gedung D Lantai 5, Jakarta 10270

Telp. 02 I -5 7 9460 53 E ax. 02t _57 9460 SZ

]tJamor

Larnpiran

: &st

1DL5t2010

eL

Desernber 201 0

F{ai

trNESColr<Erzo OBUCHI Reaserch Fellowship programmes

Kepada Yth

Para Rektor Universitas/Instjtut dan pTS di Lingkungan

Kopertis Wilayah I-XII

di Indonesia

Merujuk surat dari Komisi Nasional untuk LTNESCO perihal

LTNESCO/KEIZO OBUCHI Reaserch Fellowship programmes, d"rrgan
hormat Kami tawarkan kepada para pimpinan pr dan prS di lingkunlan
Kopertis wilayah I-XII untuk dapat mengirimkan usulan nama calon-"uion
yang potensial. Usulan disampaikan Direktorat Ketenagaan Ditjen Dikti dan
paling lambat Kami terima sebelum tanggal 3 Januari 2011.
Alamat pengiriman:

Direktorat Ketenagaan Ditjen Dikti

Jalan Jenderal Sudirman Pintu Satu Senayan
Gedung D Lantai 5
Jakarta 1027A
Demikian hal ini disampaikan untuk diperhatikan dan ditindaklanjuti.

Direktur Ketena

NIP,'tr:9600104 199703 1 A02

Tembusan Yth;

Dirjen Dikti
Sekretaris Ditjen Dikti

KOMISI NASIONAL INDONESIA UNTUK UNESCO

KEMEI{TERIAN PENDIDIKAN NA SIONAL
Jalan Jenderal Sudirman Senayan

JAKART A 102711
IgFphone. No. 57 11 | 11 (t-tunring)

Nonrol f/ O V lA12.4lLLt20t0
Lamp. : satu berkas

Hal

UNESColKElzo oBUCITI llesearch

llo*.ships progr:rnrmes
(UNESCo/Japan Young Researclrers Felr'*'ship r)r'g*rmnre)
C1'cle 201 I Japan Furrtts-in-'l'rust Pro.icct
Fe

13 t}[f;

Yth. Direktur Jenderal lrendirlihan f inggi

Kementerian Pendidikan Nasional
Gedung D Lt. 10
Jl. Jend. Sudirman Pintu Satu. Scnavan
Jakarta

Bersama

ini kami sampaikan

dengan hornrat lbtokopi surat I\4r. .1. I{ao. Thc Assistlnr

Fixternal Rclations and Coopcratiolt u.i.. i-lNfSCO Par.is I,wt,.
ERC/RPO/PPFll]1262 tanggal 3 Scptcnrbcr 2010. ),ang nrenrtrcritahul<an bahu,u
TINESCO bekerjasama dengan Thc Japan liuncis-in-Trust Pro.iect lbr Capacity,-Iluilclilg
of Human Resources Jepiurg akan nrernberikarr beasisrva kepacla 20 orang perieliri rnucla
yang terpilih dari negara*negara anggota lINllSCO. nrelipuli bidarrg lingkungan. dialoq
antar bangsa, teknologi informasi dan konrunikasi, resolusi per-tcntangonfi;Aufruiiil-

Director-General

for

Pada kesempatan

ini

penyelenggara mengundang Negara-negara anggota UNESCIO

(Sa) ,g*gcalon untuk dipilih. dan sudafi harus
diterima paling lambat tanggal 5 Januari ZOtt cti IINESCO Paris sefta Dersvaralantermasuk Indonesia untuk mengajukan Z
persvaratan

laimya.

---

sesuai kualifikasi penyelenggara persyaratan calon

-vang dia.iukan antara lain:

l.

Peneliti

2. Diutamakan wanita
3. Usia tidak lebih dati 40 tahun
4. Sehat jasmani dan rohani
5. Orang yang berintelektual tinggi
6. Kemampuan Bahasa Inggris atau Perancis

dengan baik

Untuk lebih jelasnya mengenai tawaran UNESCO. kami persilakan Saudara meneliti
surat terlampir beserta pengisian Application Forrn.
Sehubungan dengan itu, sekiranya pada instansi Saudara ada calon yang sesuai dengan
persyaratan tersebut dapat menyampaikan kepada kanii sebelunr tanggal 5.lanuari 201I
untuk kami teruskan kepada pihak penye len ggara/l-lNlls ClO.
Atas perhatian Saudara kami Llcapkan terimA kasih.

$$
Tembusan.
Sesjen Depdiknas

I.
;. 'Kal

Informcr;,

yan/ohuchi.20l I

.it

I-1.-.r

ntlo

F$ief
a llarian

untuk UNESCO

Rachman, N{.l}d

2010

UNESCO/KEIZO OBUCHI RESEARCH FELLOWSHIPS

PROGRAMME

Please complete the following

page,lt"lffii

ue attached to the apprication form:

Name of the candidate:

Country:
Age:

(applicants born before

Date of birth
E-mail

January 1971 wir not be considered under the programme).

(Day/Mo nthf/ea r)
@

Last degree obtained:

(have obtained already

a@

Tick the corresponding domain of research:

tr
tr
tr
tr

Environment (with particular emphasis on Water Sciences)

Information and communication Technologies
Intercultural Dialogue
Peaceful Conflicts Resolution

Title of proposed research project:

Duration of the proposed research studies:

From

;;;: "ffib

months

(minimum of 3 months maximum of g months)

e sure that the Research studies take

Proposed country of research studies (abroad):

Name of the Host Institution:

Total amount of the proposed research studies

us

Dollars(berween us $6,c0c to us $i0,000)

Please insure that the following documents are attached

to the application:
[Ref. Letter of announcement eRcnpotpprna.iaiann"* l, g vi
]
The UNESCO Fellowship Application Form duly
completed in dupticate ENDORSED By yOUR
NATIONAL COMISSION.

tr
tr
tr

Two recent photographs (obrigatory) shourd be incruded

with the form
A detailed description' one to two page(s) (maximum), in either
Enslish or French of the research
work for which the candidature is being puiiorwarO

tr
E
tr

A detailed budget estimate (between US $6,000 to US

$10,000)
A letter of recommendation from someone familiar with the candidate,s

work
certified copies of degrees or diplomas (including transcript
of grades) in duplicate. proof of having
obtained a Master,s deqree

n Letter of acceptance from the host institution (1 or 2countries

ABROAD)
n The certificate of language proficiency (on the uNESco form)
duly

completed in duplicate for

the language of the country of study (should this be different
from the candidate,s motnei tongue)
issued by an official authority

ERC/RPO/PPF/LZF 10 31 1 E

A
ilr[$[il

ry

united Nations Educational, Scientific and cultural organization

k
k

APPLICATION FOR FELLOWSHIP

7, place de Fontenoy, 75352 paris 07 Sp

telephone: t33,1) 45.69.1 0.00
telex: 204461 Paris

27A602 Paris

telefax UNESCO: (33.'t) 45.66.94.2E

Instructions:The apprication form should

be

accurately. The application sttould

be submitted in three capies. The

and

either typed or written in ink in block

submitted by the appropriate governmental body and each part should

be answered completely

information requested should

be

capitals. Where additional space is

needed, a separate sheet should be
useci and attached in three copies.

A. Offlcial presentation
The Government

presents herewitn

the candidature
in the field

of

....

for

UNESCO fellowship

...

under Programme and/or

project..............

The undersigned certifies that it is the Governrnent's intention to have

organized a programme of study such that will permit the candidate
to increase his contribution to the development of his country in the
future.

lf a fellowship is granted, the Government will:

(a) provide the necessary assistance to the felfow for
departure to
begin
the study programme;

(b) assist the fellow in meeting personal and farnily responsibilities

during the period of his
.fellowship by maintainl-ng, if necessary,
continuation of the whole
or part of tiis preset'ni remuneration;
(c) facilitate employrnent of the feltow in the assignment mentioned
in this application upon completion of the fell;wship.

It is certified that
accurate.

inforrnation contained herein

is comptete

PRESENTED FOR:

(seal)

il;il;;il;;il
Date

B. Background data concerning the candidate

IMP/0023A (x,95)

Name anA'rii6';i';e;pc;;;idi;'oin;di'

Signature

"""'

and

Education
Years attended

Name, place and country

of educational establishments

from

to

Degrees, diplomas:

Date

Indicate main subjects

obtained

Secondary, technical, etc

Post-secondary, university, or equivalent

IMPoRTANT: This application is not considered complete unless accompanied

by certified copies of diplomas received and academic transcripts of courses followed and grades or marks obtained

Other studies
Mention any other studies undertaken, including training/refresher courses

Fellowships and scholarships

which of the above studies were undertaken with a fellowship or scholarship? Mention the sponsor
of the grant

Visits abroad
List any significant visits abroad not mentioned above

Publications and research

List any significant publications (including publisher and date of publication) and any major
research projects undertaken

Languages
Mother tongue:
Understand

Read
Easily

Speak

(spoken)

Other languages
Not
easily

Easily

Not
easily

Fluently

Write
Not

fluently

Easily

Not
easify

The UNESCO certificate of language knowledge should be completed and attached to this application

References
List three persons, not related to the candidate, who can provide information on his/her qualifications.
These persons should normally be
teachers or supervisors acquainted with the candidate's previous academic work

Previous professional activities

Dates of service

Employer

From

Responsibilities

To

Present position
Current duties

C. Training objectives
lndicate field of study and particular areas

Nature of studies
oiffi

Should the studies be ciirected

tou.rard ;
or qualification or should the studies have miinty 'a practical or

applied orientation?

should the programme include preparation of a thesis or other

piece of research?
ls the purchase of special equipment required?

Place(s) of study

In order of preference, suggest countries of study and list below thern

any preferences for institutions where the studies could be
undertaken
1.

and/or

and/or

{others}

ForwhatreasonSaretheinstitutions|istedaboveu"ing;'opm

MentionanypreviouscontactWiththeseinstitutionsandattachconRimffi
IMPORTANT: Any further contact for the fellowship programme
should be made only through UNESCO

Details of proposed studies

{lf additional space is needed, separate sheets should be attached)

Give precise details of studies to be undertaken

Give realistic budget estimates for the fellowship requested (return

travel, monthly allowance, tuition fees, etc.)

Expected results and future assignment

Indicate how it is envisaged to make the best use of the results
achieved and specify what position will be taken up at the
end of the fellowship with a description of future responsibilities

Candidate's statement
lf UNESCO grants me a feilowship I agree ro take up after my period of study
the position to be assigned to me as described
above. I certify the information I have-provided is complete and accurate

Candidate's signature

[|tt$[[

united Nations Educationat, Scientific and Cultural Organization

7, place de Fontenoy, 75952 paris 07 Sp

telephone: (33.1 ) 45.6S.1 0.00

APPLICATION FOR FELLOWSFIIF

CERTIFICATE OF LANGUAGE KNOWLFDGE

(1)

ABILITY TO UNDERSTAND

(a)
(b)
(c)
(2)

Understands without diffielty when addressed at normal rate....--...............-.-.-.......

Understands almost everything, if addressed slowty and
Requires lrequenl repetilion and/or translation of words and phrases.....

carefully..-..

...-.....,.......-..................

_.................

ABILITY TO SPEAK
(a)

(b)
(c)
(3)

Writes slowly and/or with only a moderate degree of accuracy.......

Writes wilh ditf,cutty and makes freguent mistakes-............

READING ABILIry AND COMPREHENSION

(b)
(c)
(5)

Reads slowly, bLrt understands almosl everything he reads............ReaG with difficulty, and onry with trequent recourse to the crictionary

TECHNICAL LANGUAGE
Certain fellowships require a particular knowledge of specialized or technical language. In such cases,
please evaluate candiclate's ability with reference to paras. 1, Z, and 4 above.

(6)

Please indicale any further facts about candidate's language knowledge which may be of value in the
development of his programme:

I3NGUAGE TEST HAS BEEN MADE BY

Name:
Title:....".

tMPlOozT (x,95)

trr
f-l

ABILITY TO WRffE

{b)
(c)
(4)

Speaks intettigibly, but is not fluent

Speaks hattingly, and is often at a lqss for words and phrases...............

tr=
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