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 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. Submitting more than one application leads to disqualification.

The selection will be held in May 2011 and the result will be announced to the applicants at the latest by end of
June 2011.
 Failure to react to Nuffic Neso Indonesia’s correspondence / e-mail within 48 hours can lead to cancellation of the
scholarship.

 If at any time after awarding of the scholarship it becomes clear that the applicant has made inaccurate 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.
 Application forms and documents will not be returned.

B. ENCLOSURES:
Attach only certified copies of documents.
 Admission letter by host institution in the Netherlands;

 Certificate of `TOEFL Internet-Based Test Examinee Score Report’ minimum score .80 or `International

English Language Testing System Test Report Form (IELTS Report Form)’ minimum score. 6.0;;


Curriculum vitae, see format on the website www.nesoindonesia.or.id;

Copy SK for government officials or ‘kontrak kerja’ for others;



Legalized copies of original diplomas and transcripts;

Legalized copies of translated diplomas and transcripts;

 Copy of KTP or copy of passport;
 2 recent photographs (3x4; colour)

The closing date is 31 March 2011

Two complete copies of application form should be submitted. Completion in stages is not possible

C. SELECTION PROCEDURE
The time scheme below is subject to minor changes.

Apr All applications are checked on their completeness and entered into a database. Incomplete applications
will not be processed. Candidates who are disqualified during this stage will receive written notice.
Based on the formal StuNed criteria a list of eligible candidates is presented composed for t to 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.

May Selected candidates will be notified through a letter via e-mail, conveying extensive information about
procedures to be followed-up, the Rules and Regulations of the StuNed programme, a package with
information about the Netherlands and information about the visa procedure.

Jul Awardees will be invited for a pre- departure briefing in Jakarta and Surabaya. Those who live too far
away from Jakarta will be invited for a briefing at the Nuffic Neso Indonesia office prior to departure

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

name :
FOR OFFICIAL USE ONLY

2
 male female
Documents Y N
email 1 : 2 recent photographs
Employer Statement
email 2 :
Applicant's Declaration
Admission Letter
IBT/IELTS
CV
SK
GPA: S1 S2
Original Diploma
GPA MAX GPA MAX Translated Diploma
Original Transcript
Translated Transcript
IBT / IELTS: test date: KTP or Passport

Eligibility Y N
Chosen Programme
Admission Letter
GPA
chosen programme:
Full Time / Part Time
2 years working exp.
university in NL: TOEFL/IELTS/IBT
score
Others
duration: months
Selection
Partner
MASP
F/M
employer: Java / Outside Java
(name of institution) Score

city:
Final Result
province.:

employed since: dd/mm/yyyy

Scholarship Award
applicants position:

position held since: dd/mm/yyyy

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 5.

3
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.

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 FOR WHICH YOU HAVE BEEN ADMITTED

Please enclose the admission letter of the Institution in the Netherlands.

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

3. EDUCATIONAL RECORD

a. Undergraduate Education
Please enclose certified copies of relevant diplomas and transcripts

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

4
b. Postgraduate Education & Training
Please enclose certified copies of relevant diplomas or certificates and transcripts

Name of institution
Place of Institution
Duration From: Until:
Main field of study
Diploma or degree obtained  S-2  Master’s Degree  Other

4. PRESENT EMPLOYMENT

Name of Institution / Company /

Organisation
(Faculty/Department)

Brief description of the

company and the service it
provides

Address Telephone:
Fax:
E-mail Address:

Website:
Employed Since (dd/mm/yyyy)
Present position
Employment for hours a week

Describe your current duties and

responsibilities

This position held since (dd/mm/yyyy)

5. MOTIVATION STATEMENT
The statement should be typewritten and composed only by the applicant him/herself.

No. Criteria Explanation

A. Explain in 50 words which
experiences/considerations contributed
to the choice of your current job.
5
 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 how the chosen

study programme will benefit
Indonesia in general.

6. MISCELLANEOUS

(TICK ONLY ONE ITEM)

How did you find out about the StuNed  Nuffic Neso Indonesia Website
Scholarship Programme for the very first
time?

(please take time to fill in this question, to

enable us to develop the best promotion
strategy)
6
  Nuffic Neso Indonesia Presentation at the Neso

office (please indicate ...............................)

Where/How did you get the information
about the study programme for which you
apply?
 Nuffic Neso Indonesia Presentation at your office (please
indicate ...............................)
 Article in print media (please indicate
………………………)
 Advertisement in print media (please indicate ……………..)
 Radio (please indicate…………………………)
 Holland Education Fair (HEF)
 Your Institution
 Friends
 StuNed alumnus
 StuNed brochure/poster
 Nuffic Neso Indonesia office in Jakarta/Surabaya
 Others (please Indicate …………….....................................
…)
(TICK ONLY ONE ITEM)
 List of Courses on the Nuffic Neso Indonesia website
 Holland Education Fair (HEF)
 Nuffic Website
 Course Provider Website
 Friends
 Your Institution
 Nuffic Neso Indonesia 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?  Yes, year ………..

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?

7
7. STATEMENT BY THE EMPLOYER

I, the undersigned, being authorised to supply Name Applicant:

the following particulars hereby certifies that
Mr/Mrs/Miss.:

is employed by our organisation

Since:
Department:
Position: for hours a week
Position held since:

and is applying for a StuNed scholarship to

follow a master programme in The
Netherlands in the field of

Name of the study programme

Please explain fully why the master

programme 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
continue to be employed by your
organisation after completion of her/his
study?

Which position will be offered to the Department:

candidate after successful completion of
her/his study?

I certify that all my answers are true, complete and correct, and that if the candidate is awarded a StuNed
scholarship, my organization will comply with all the formal obligations this entails.

Name (of organization) :

Name (of contact person) :

Position :

Date :

Place :

Signature and official stamp : (please sign on materai)

8
8. APPLICANT’S DECLARATION

I completely understand the conditions under which the scholarship is offered, and if I am awarded a
StuNed scholarship I agree:

1. to comply with all the formal obligations mentioned in the Rules & Regulations of StuNed.

2. to return to my home country immediately after the programme has ended, regardless of the time

remaining on my visa;, or at any time immediately if and when summoned by Nuffic Neso Indonesia.
3. to be available for the entire period of the study programme and be able to take part in the entire programme.
4. to give permission to enter my personal data in a database which may be used at Nuffic Neso Indonesia’s
discretion to provide information to other related (non commercial) organisations.
5. to abide by the rules and regulations governing the student visa and stay permit;
6. to submit any progress reports whenever required;
7. to act in such a manner that will not bring disrepute or cause any formal damage to any party involved in the
programme including the host institution, the image of Indonesian students in the Netherlands, Nuffic Neso
Indonesia and accept to be called back to Indonesia without any formal appeal in case I breach this promise;
8. to participate in activities organised in relation to the StuNed scholarship during the programme and after I
have returned to Indonesia;

9. not to engage in employment in the Netherlands other than the allowed maximum of ten hours a

week;, and to inform and update Nuffic Neso Indonesia of any details of such employment if any;
10. to inform Nuffic Neso Indonesia immediately should I visit Indonesia for any reason during the time frame of
my scholarship and that if I fail to do so my scholarship may be terminated.
11. not to hold another scholarship that would give any overlapping benefits without Nuffic Neso Indonesia’s
written approval.

Furthermore:

12. I am not aware of any medical condition (disability, illness or pregnancy) which might prevent me from
completing my study programme within the time allowed for the scholarship.
13. I fully understand that if I am awarded a StuNed scholarship, it may be subsequently withdrawn if I fail to
make adequate progress, or for other sufficient cause determined by the Government of the Netherlands or the
institution at which I am studying.
14. I commit to inform Nuffic Neso Indonesia immediately of any circumstances (serious illness, incapacity,

THE ORIGINAL APPLICATION FORM AND ITS ANNEXES TOGETHER WITH A COMPLETE
COPY SHOULD BE SENT TO:
Nuffic Neso Indonesia
Menara Jamsostek 20th Floor
Jalan Jend. Gatot Subroto No.38
Jakarta 12710