www.nesoindonesia.or.

id

Menara Jamsostek 20th floor,

Jl. Gatot Subroto no. 38, Jakarta 12710
p +62 (0)21 5290 2172
f +62 (0)21 5290 2173

APPLICATION INFORMATION

A. INSTRUCTIONS FOR THE APPLICANT:

 Answer questions 1 through 10 clearly and completely, in English or Indonesian, typewritten. Do not

change the lay out of the original form.

 You may submit one application only. Submiting more than one application leads to disqualification.

 There will be no correspondence about submitted forms.

 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 (1 original + 1 copy) of the application form and documentation are required.

B. ENCLOSURES:
Attach only certified copies of documents. Do not attach original documents. The application form and documents
will not be returned.


your area;
Copy of original Institutional/Prediction TOEFL test from a recognized testing institute in
  Curriculum vitae (see format CV at www.nesoindonesia.or.id);

 Copy SK for government officials and lecturer of state universities or “kontrak kerja” for others;

 Legalized copies of original diplomas and transcripts;

 Legalized copies of translated diplomas and transcripts;

 A personal and original letter of recommendation on letterhead referent’s office (Kop surat pemberi referensi);
 Copy of KTP;

 3 recent photographs (3x4; colour).

The closing date is 15 October 2010.

Applications received after 15 October 2010 and incomplete applications will not be processed.
Two complete copies of application form should be submitted. Completion in stages is not possible.

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PRE-REGISTRATION APPLICATION FORM
MASTER PROGRAMME 2011 Please attach
a recent
photograph
TO BE FILLED IN BY APPLICANT 3x4

name:
male female FOR OFFICIAL USE ONLY
Region:
KTP / NIP:
BO SM UN WK
BC
email:
JU
JKT
NJ
English proficiency:
TOEFL ibt □
GPA: S1 S2 ielts □
itp □
non itp □
non ielts □
others □

GPA MAX GPA MAX

TOEFL / IELTS: test date:

TEST CENTRE:

criteria:
1. Embassy Partner
yes 50
chosen programme: no 0
2. Non Embassy Partner but
study programme in line with
MASP
university in NL: yes 25
no 0
3. Female candidate
duration: months yes 10
no 0
4. Total score

selection:

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employer: 1. > 2 Y
(name of institution)

city: 2. HWK

prov.:
3. CBC
employed since:
4. CSC
applicants position:
(specify)
position held since:

PRE-REGISTRATION APPLICATION FORM

MASTER PROGRAMME 2011

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 6.

1. PERSONAL INFORMATION
All data exactly as they ( will) appear in your passport !

Name Male  Female 

Place/Date of Birth Place: Date:
Marital Status Single  Married  Children 
Email Address 1. 2.
NIP for Public Sector Applicant

Home Address

Telephone / Fax / Mobile Home *:

* obligatory
Mobile Phone *:
Passport number Nr. Date of issue: Date of expiry:
Parents’ address
(or next of kin)

Telephone / E-mail

2. THE COURSE YOU ARE INTERESTED IN

Name of university

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 Study programme
Period of this course From: Until: Duration : months
Name of contact person / email
Total tuition fee for this course EUR
Minimum TOEFL / IELTS
requirement for this course

3. EDUCATIONAL RECORD

a. Elementary School (SD)

Type of school
Name of school
City and Province
Year of graduation

b. Junior High School (SMP)

Type of school
Name of school
City and Province
Year of graduation

c. Senior High School (SMA)

Type of school
Name of school
City and Province
Year of graduation

d. Undergraduate Education

Please enclose certified copies of relevant diplomas, degrees, certificates and transcripts.

Name, place, country of

institution
Field of study
Diploma or degree obtained  S-1 (or equivalent) Year of graduation ……………..

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 e. Postgraduate Education & Training

Please enclose certified copies of relevant diplomas, degrees, certificates and transcripts.

Name and place of institution

Duration From: Until:

Main field of study

Diploma or degree obtained  S-2  Master’s Degree  Other

4. FOREIGN LANGUAGE ABILITY

A. Attach the latest Institutional/Prediction TOEFL or IELTS result test. Please keep in mind that you must

have a minimum IELTS score of 6.0 after you conclude the English for Academic Purpose (EAP) course (for many
English taught programs higher entry requirements may be in place).

English:  excellent  good  fair  elementary

Dutch:  excellent  good  fair  elementary  not at all
Others:  ………...  …………  ………  ………….  ………….

B. What are you currently doing to enhance your English?

5. PRESENT EMPLOYMENT

Name of Institution / Company /

Organisation
(Faculty/Department)

Brief description of the

Institution/ Company/
Organisation and the service it
provides

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 Type of organization 1. Central Government
2. Local Government
3. State University
4. Private University
5. Media
6. Non-Governmental Organization (NGO)
7. Other Educational Institute
8. BUMN
9. Private Company
Telephone:
Fax:
Address
E-mail Address:

Website:
Employed Since (dd/mm/yy)

Present position Employment for hours a week

Describe your current duties and

responsibilities

This position held since

(dd/mm/yy)

6. MOTIVATION STATEMENT

The statement should be typewritten and composed only by the applicant him/herself. If possible in English, if not
answer in Bahasa Indonesia. If more space needed expand space until maximum 2 pages. Start question number 7 on
new page.

No. Criteria Explanation

A. Explain in 50 words which
experiences/considerations contributed
to the choice of your former study.

Jelaskan dalam 50 kata mengenai

pengalaman/pertimbangan dalam
memilih program studi sebelumnya (S1)

B. Explain in 50 words which

experiences/considerations contributed
to the choice of your current job

Jelaskan dalan 50 kata mengenai

pengalaman/pertimbangan dalam
memilih bidang pekerjaan saat ini.

C. Explain in 100 words the relevance of

the chosen program to the current
development of your organization (long
term development plan) and the sector
you work in.

Jelaskan dalam 100 kata keterkaitan

antara program studi yang dipilih
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 dengan pengembangan
institusi/perusahaan (rencana
pengembangan jangka panjang) dan
bidang kerja saat ini.

D. Describe in 100 words how the chosen

study will benefit Indonesia in general.

Jabarkan dalam 100 kata bahwa

program studi yang dipilih akan
bermanfaat bagi Indonesia secara
umum.

E. Describe in 50 words which

job/position you expect to hold in ten
years time.

Jabarkan dalam 50 kata mengenai

pekerjaan/jabatan yang diinginkan
dalam waktu 10 tahun mendatang.

7. MISCELLANEOUS

(TICK ONLY ONE ITEM)

How did you find out about the StuNed
Scholarship Programme for the very first


time?

(please take time to fill in this question, to

enable us to develop the best promotion Neso Website
strategy)

 Neso Presentation (please

indicate ...............................)


………………………)
Article in print media (please indicate


……………..)
Advertisement in print media (please indicate

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  Radio (please indicate…………………………)

 Holland Education Fair (HEF)


 Friends
Your Institution

 StuNed alumnus

 StuNed brochure/poster

 Neso office in Jakarta/Surabaya

 Others (please Indicate …………….....................................…)

(TICK ONLY ONE ITEM)
Where/How did you get the information
about the study programme for which you


apply?

List of Courses on the Neso website


 Nuffic Website
Holland Education Fair (HEF)

 University Website
 Friends

 Your Institution

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  Neso office in Jakarta/Surabaya

 Others (please indicate................................................................)

Did you ever attend the StuNed Presentation  No

in your region?  Yes:
University BAPPEDA/PEMDA YEAR:…………
CITY:…………

Have you applied for StuNed Scholarship  No

Programme before?

Are you in good health and fit for studying

 Yes, year ………..

abroad?

8. FUNDING

Have you ever been awarded a scholarship?  Yes  No

If so, from which organisation?

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?

10. APPLICANT’S DECLARATION

I certify that all my answers are true, complete and correct.

Date :

Name :

Place :

Signature :

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THE ORIGINAL APPLICATION FORM AND ITS ANNEXES TOGETHER WITH A
COMPLETE COPY SHOULD BE SENT TO:

NUFFIC NESO INDONESIA

Scholarships Section
Menara Jamsostek 20th floor
Jalan Jend. Gatot Subroto no.38
Jakarta 12710

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