www.nesoindonesia.or.

id
Menara Jamsostek 20th Floor,
Jl. Gatot Subroto No. 38, Jakarta 12710
P +62 21 5290 2172
F +62 21 5290 2173

APPLICATION INFORMATION
SHORT COURSE 2016
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 (apply for one course only). Submiting more than one application (more than
one course) leads to disqualification of all your applications.
The selection will be held in October2016 and the result will be announcedto the applicants atthe latest by mid
November2016.
Failure to react to Nesos correspondence/e-mail within 5 working days can lead to cancellation of the
scholarship.
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 of the application form and documentation are required.
Application form and documents will not be returned.

B. ENCLOSURES:
Attach only certified copies of documents.
Unconditional admission letter by Dutch Higher Education Institution in the Netherlands for the course you are
applying;
Certificate copy of `TOEFL Internet-Based Test Examinee Score Report minimum68 or `International English
Language Testing System Test Report Form (IELTS Report Form) minimum score5.5; (If required applicant
should be able to provide NESO Indonesia the original test certificate). This requirement is waived if you have
obtained a degree from an English-speaking country within two years since you are awarded by submitting a
transcript and diploma from the institution attended.
Curriculum vitae, see format on website www.nesoindonesia.or.id;
Copy SK for government officials or kontrak kerja for others;
Legalized copies of original diplomas and transcripts of Bachelors/S1 and Masters/S2 (if applicable)
Copy of relevant award or achievementcertificates (if applicable)
Copy of your publications abstract (if applicable)
Copy of KTP or copy of passport
One recent photograph (3x4; colour)

The closing date for receiving applications is 1 September 2016

Applications received after the closing date and incomplete application will not be processed.
Twocomplete sets of application form (hardcopy) should be submitted. Completion in stages is not
possible.
C. SELECTION PROCEDURE
1 September2016

All applications are checked on their completeness. Incomplete applications will not be
processed.
Based on the StuNedcriteria a list of eligible candidates is composedfor 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 are not able to accept the
scholarship, candidates on the ranked reserve list will be awarded the scholarship.

Mid November 2016

All candidates will be notified of the selection outcome through e-mail. Selected candidates
will receive informationabout procedures to be followed-up, the Rules and Regulations of the
StuNed Scholarship programme, a package with information about the Netherlands and
information about the visa procedure.

APPLICATION FORM
SHORT COURSE2016
Please attach
a recent
photograph
3x4

TO BE FILLED IN BY APPLICANT

Name:
Male Female
E-mail 1 :

Sinndy Maria Saerang

FOR OFFICIAL USE ONLY
Checklist D

sinndy_ms@yahoo.co.id

Application form

E-mail 2 :

Employer statement
Applicant's declaration
Admission letter

GPA:

S1

GPA

MAX

TOEFL IBT / IELTS:

3.24

GPA
ITP 500

4.00
S2

3.80

4.00

MAX

English proficiency
CV
SK

Test date:

dd

mm

yy

Legalized diploma
Legalized transcript
KTP or Passport

Checklist E
2 years of work experience

StudyProgramme:

Full time/Part time

Employer Statement

University in NL:

SK
GPA
English proficiency

Duration:weeks

Admission Letter
Study Programme
Not a current recipient of
StuNed/NFP

Employer:
(Name of Institution)
City:
Province:
Employed Since:

(dd/mmm/yyyy)

Applicant Position:
Position Held Since:

(dd/mmm/yyyy)

APPLICATION FORM SHORT COURSE 2016

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
Place / Date of Birth

/ (dd/mm/yyyy)

Marital Status

Single

E-mail Address

1.

2.

City:

Province:

Home:

Mobile:

Married

Children

Yes No

Address
Telephone
Emergency Contact
(or Next of Kin)

Relationship:
E-mail:

Tel:

2. STUDY PROGRAMME
Please enclose the admission letter from the Dutch University or Institution.
University Name
Study Programme
Program Period

From:(dd/mm/yyyy)to(dd/mm/yyyy)

Contact Person
Total Tuition Fee

Duration:weeks
E-mail:

EUR

3. EDUCATIONAL BACKGROUND
a. Undergraduate Education
Please enclose certified copies of relevant diplomas and transcripts
University orInstitution

Country:

Study Programme
Award Obtained

Bachelor Other

Year of graduation:

GPA

b. Postgraduate Education or Training

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

Country:

Study Programme
Award Obtained

From(dd/mm/yyyy) to(dd/mm/yyyy)

Master

Other

Year of graduation

4. ENGLISH PROFICIENCY
Please enclose copy of your Test Result.
Test Name

IBT TOEFL

IELTS

5. PRESENT EMPLOYMENT

Test Score ..............

Test Date:

GPA

Employer (Name of
Institution)
Department/Directorate
Present Position
This Position Held Since

(dd/mmm/yyyy)

Employed Since

From:(dd/mmm/yyyy)

Employment For

To:(dd/mmm/yyyy)

Hours a week

Describe Your Current

Duties And
Responsibilities

Address

City:

Province:

Phone:

Fax:

E-mail:

Website:

Brief description of Your

Institution

6. MOTIVATION STATEMENT
The statement should be typewritten and composed only by the applicant him/herself.
No.

Criteria

A.

Explain in 200 words (max)the

relevance of the study programme to
your personal and career
development

B.

Explain in 200 words (max)the

relevance of the study programmeto
the current development of your
organization (long term development
plan) and the sector you work in

C.

Explain in 200 words (max)how the

study programme will benefit
Indonesia in general.

Explanation

7. MISCELLANEOUS
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How did you find out about the StuNed

Scholarship Programmefor the very first
time?

(TICK ONLY ONE ITEM)

Nuffic Nesowebsitewww.nesoindonesia.or.id
Study in Holland website: www.studyinholland.nl
Article in print media on ..
Advertisement in print media in.
Radio (channel: (please indicate
Ducth Placement Day / European Higher Education Fair
Holland Scholarship Day
Holland Scholarship Info Session at.
Your institution
Friends

StuNed alumnus

StuNed brochure/poster

Nuffic NesoIndonesia office

Other, please indicate .....................................

Where/How did you get the information
about the study programme for which you
apply?

Have you been awarded StuNed or NFP

Scholarship Programme before?
Have you ever been awarded other
scholarships?

(TICK ONLY ONE ITEM)

List
of
courses
on
the
Neso
website
or
www.studyfinder.nl
Dutch Placement Day / European Higher Education Fair
Holland Scholarship Day
Holland Scholarship Info Session
Study in Holland website: www.studyinholland.nl
Dutch Higher Education Institution website
Friends
Your institution/employer
Nuffic Neso Indonesia office
Other, please indicate .....................................
No
Yes,

yearProgramme: PhD
Made Training

Yes

No

If so, from which organisation/donor?

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?

MA SC Tailor-

8. STATEMENT BY EMPLOYER
I, the undersigned, being authorised to
supply the following particulars hereby
certifies that:

Name of Applicant:
Employed Since:(dd/mm/yyyy)
Department/Directorate:
Current Position:
for .. hours a week
Position Held Since: (dd/mm/yyyy)

And is applying for a StuNed scholarship to follow a short course programme in The Netherlands in the field
of / name of the study programme:
Dutch Higher Education Institution (University) in the Netherlands :

Please explain fully why the short course is important to your organisation (and to the applicants work in the
future) :

Do you guarantee that if the candidate is awarded with the scholarship, he/she will be given permission to
attend the program/course for the entire period of the programme? Yes No
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? Yes No
Which position will be offered to the
candidate after succesful completion of
her/his study?

Department:

I certify that all my answers are true, complete and correct, and that if the candidate is awarded a StuNed
scholarship, my organization will fully support and comply with all the formal obligations this entails.
Name, complete address& contact number (of organization) :
Name (of contact person) and Position*:
E-mail address:
Date:
Place:
Signature and Official Stamp (Obligatory):

(please sign on materai (obligatory)

Acknowledgementfrom Human Resource Division

Name and Signature (Affix Official Stamp)

Date:

*) the lowest level of employer authorisation should be at least senior manager/general manager/ echelon 2 command
( for government institution) or the equivalent level who is responsible for administrative and functional direction of
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group of staff or employees. Failure upon providing sufficient authorisation will lead to disqualification of
application.
9. CO-FUNDING (Optional)

StuNed has ambitious targets to support a high number of excellent Indonesian students for their studies in the
Netherlands with a StuNed scholarship Therefore, we encourage participation from various stakeholders to co-invest
in this scholarship programme. The employer of the applicant, the applicant themselves, and any other organisation
can co-fund the programme in the form various cost allocation namely living allowance, international travel, and
other studying related costs.
For the employer, this would be efficient use of available training budget, while at the same time enhancing the
chance for the applicants to be awarded. Contributors would be specifically mentionedand acknowledged in the
publicity campaign around the awarding of the scholarship.
IMPORTANT notice: co-funding does not guarantee the award of a StuNed scholarship. In the selection process the
committee first looks at 1) eligibility of the candidate 2) excellence 3) link to the priority areas. If applicants achieve
the same score in the selection on these 3 criteria the co-funding will play a role, meaning that at that point
candidates with co-funding will receive preferential treatment.
If you wisht to apply for co-funding scheme, please select the available co-funding option(s) as stated below You
may choose more than one option.

9.1 Source of Funding.

9.1.A.Employer (please indicate)

Government Institution

Non-Government Organization (NGO)

Corporate Organisation
Indonesian University/ Education Institution

9.2 Form of Contribution

Please state the form(s) of contribution to be committed:

Tuition fee: (please indicate)

100% of total tuition fee of the study programme
50% of total tuition fee of the study programme
25% of total tuition fee of the study programme

Cost of living including housing(approximately EUR 32 per day*number of days of the course)
International travel

9.3 Statement of Commitment (to be signed by the funder)

I hereby would like to declare my commitment to give the abovementioned contribution to support the
applicant for short courses study programme in the Netherlands if she/he gets awarded a StuNed
scholarship.
Name, complete address & contact number (of organization) :

Name (of contact person) and Position:

E-mail address:

Date:

Place:

Signature and Official Stamp (Obligatory):

9. CO-FUNDING (Optional)

9.1 Source of Funding.

9.1.B.Self-financed (StuNed applicant)

9.2 Form of Contribution

Please state the form(s) of contribution to be committed:

Tuition fee: (please indicate)

100% of total tuition fee of the study programme
50% of total tuition fee of the study programme
25% of total tuition fee of the study programme

Cost of living including housing (approximately EUR 32 per day*number of days of the course)
International travel

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9.3 Statement of Commitment (to be signed by the funder)

I hereby would like to declare my commitment to give the abovementioned contribution to support for the
applicant forshort courses study programme in the Netherlands if she/he gets awarded a StuNed
scholarship.
Name, complete address & contact number:

Name (of contact person) and Position:

E-mail address:

Date:

Place:

Signature on Materai (Obligatory):

9. CO-FUNDING (Optional)

9.1 Source of Funding.

9.1.C. The Dutch University you are admitted to

9.2 Form of Contribution

Please state the form(s) of contribution to be committed:

Tuition fee: (please indicate)

100% of total tuition fee of the study programme
50% of total tuition fee of the study programme
25% of total tuition fee of the study programme

Cost of living including housing (approximately EUR 32 per day*number of days of the course)
International travel

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9.3 Statement of Commitment (to be signed by the funder)

I hereby would like to declare my commitment to give the abovementioned contribution to support the
applicant for short courses study programme in the Netherlands if she/he gets awarded a StuNed
scholarship.
Name, complete address & contact number (of organization) :

Name (of contact person) and Position:

E-mail address:

Date:

Place:

Signature and Official Stamp (Obligatory):

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9. CO-FUNDING (Optional)

9.1 Source of Funding.

9.1.D. Other Source of Funding (please specify!)

9.2 Form of Contribution

Please state the form(s) of contribution to be committed:

Tuition fee: (please indicate)

100% of total tuition fee of the study programme
50% of total tuition fee of the study programme
25% of total tuition fee of the study programme

Cost of living including housing (approximately EUR 32 per day*number of days of the course)
International travel

9.3 Statement of Commitment (to be signed by the funder)

I hereby would like to declare my commitment to give the abovementioned contribution to support the
applicant for short courses study programme in the Netherlands if she/he gets awarded a StuNed
scholarship.
Name, complete address & contact number (of organization) :

Name (of contact person) and Position:

E-mail address:

Date:

Place:

Signature and Official Stamp (Obligatory):

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10. APPLICANTS DECLARATION

I completely understand the conditions under which the scholarship is offered, and if I am awarded a
StuNed scholarship I agree:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.

to comply with all the formal obligations mentioned in the Rules & Regulations of StuNed;
to return to my home country immediately after the programme has ended;
to be available for the entire period of the study programme and be able to take part in the entire programme;
to give permission to enter my personal data in a database which may be used at Nuffic Neso Indonesias
discretion to provide information for non- commercial purposes;
to abide by the rules and regulations governing the student visa and stay permit;
to fill in online end- of- course questionnaire;
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;
to participate in activities organised in relation to the StuNed scholarship whenever required;
not to engage in employment in the Netherlands other than the allowed maximum of ten hours a week, and to
inform and update Neso of any details of such employment if any;
not to hold another scholarship that would give any overlapping benefit without Nuffic Neso Indonesias written
approval (not applicable for applicant with co-funding scheme)

Furthermore:
11. I commit to inform Nuffic Neso Indonesia immediately of any circumstances (serious illness, incident,
incapacity, pregnancy, arrest, exclusion, death of relatives, problems at home, etc.) that occur during my study
and that might affect the progress of my course. I realise and consent that Nuffic Neso Indonesia may
terminate the scholarship;
12. 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;
13. If reports from the host institutions give reason to doubt a successful continuation of the study, the scholarship
may be terminated with immediate effect.
I certify that all my answers are true, complete and correct.
Date

Name

Place

Signature

(please sign on materai (obligatory)

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

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