www.nesoindonesia.or.id
Menara Jamsostek 20 th
Floor,
Jl. Gatot Subroto No. 38, Jakarta 12710
P +62 21 5290 2172
F +62 21 5290 2173
 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.
 The selection will be held in November 2015 and the result will be announced to the applicants at the latest by
December 2015.
 Failure to react to Neso ’s correspondence/e-mail within 3 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.
Attach only certified copies of documents.
 Unconditional Letter of Admission by Dutch Higher Education Institution in the Netherlands for the course you are applying;
 Certificate copy of `TOEFL Internet-Based Test (IBT) Examinee Score Report’ minimum 68 or `International
English Language Testing System Test Report Form (IELTS Report Form)’ minimum score 5,5; (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 bachelor degree (S1) is required;
 Copy of KTP or copy of passport
 One recent photograph (3x4; colour)
October 2015 All applications are checked on their completeness. Incomplete applications will not be processed . Candidates who disqualify during this stage will receive a written notice.
Based on the formal StuNed criteria a list of eligible candidates is composed for 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.
November 2015 Selected candidates will be notified through e-mail, conveying extensive information about 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.

Name :
Male

Female

E-mail 1 :
E-mail 2 :
Please attach a recent photograph
3 x 4
GPA: S1 S2/S3
GPA MAX GPA MAX
TOEFL IBT / IELTS: Test date: dd mm yy
Chosen Programme:
University in NL:
Duration: weeks
Employer:
(Name of Institution)
City:
Province:
Employed Since: (
Applicant Position:
Position Held Since: (
2
FOR OFFICIAL USE ONLY
Y Documents
Application form
Employer statement
Applicant's declaration
Admission letter
TOEFL IBT/IELTS
CV
SK
Original diploma
Original transcript
KTP or Passport
N
Eligibility
2 years of work experience
Full time / Part time
Y
Employer Statement
SK
GPA
IELTS/IBT
Study Abroad
Admission Letter
Chosen Programme
Tuition Fee
StuNed/NFP awardee
Selection
2015 EKN
2015 GMF
2015 JOJ
2015 MIB
Total score
Score
N
Final Result Y / N
Scholarship Award

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.
All data exactly as they (will) appear in your passport !
Name
Place / Date of Birth
Marital Status
E-mail Address
Address
(dd/mm/yyyy)

Single

Married Children

Yes

No
1. 2.
City: Province:
Telephone
Study Programme
Program Period
Contact Person
Total Tuition Fee
Home:
Emergency Contact
(or Next of Kin)
E-mail:
Please enclose the admission letter from the University or Institution.
University Name
Mobile:
Relationship:
Tel:
From: (dd/mm/yyyy) to (dd/mm/yyyy) Duration: weeks
E-mail:
EUR
Minimum TOEFL/IELTS
a. Undergraduate Education
Please enclose certified copies of relevant diplomas and transcripts
University or Institution Country:
Study Programme
Award Obtained

Bachelor

Other …………… b. Postgraduate Education or Training
Please enclose certified copies of relevant diplomas, degrees, certificates and transcripts .
University or Institution Country:
GPA
Study Programme From (dd/mm/yyyy) to (dd/mm/yyyy)
Award Obtained

Master

Other ……………
Please enclose copy of your Test Result .
Test Name

IBT TOEFL

IELTS Test Score .............. Test Date:
GPA
3

4. PRESENT EMPLOYMENT
Employer (Name of
Institution)
Department/Directorate
Present Position
This Position Held Since (dd/mmm/yyyy)
Employed Since
Employment For
Describe Your Current
Duties and
Responsibilities
From: (dd/mmm/yyyy)
Hours a week
City:
Address
Phone:
To: (dd/mmm/yyyy)
Province:
Fax:
E-mail: Website:
Brief description of your
Institution
The statement should be typewritten and composed only by the applicant him/herself.
No. Criteria Explanation
A.
B.
C.
Explain in 100 words the chosen study programme to your personal and career development
Explain in 100 words the relevance of the relevance of the chosen study programme to the current development of your organization (long term development plan) and the sector you work in.
Describe in 100 words how the chosen study programme will benefit
Indonesia in general .
4

How did you find out about the StuNed
Scholarship Programme for the very first time?
(TICK ONLY ONE ITEM)
 Nuffic Neso Indonesia website
 Nuffic Neso Indonesia presentation at the Neso office
 Nuffic Neso Indonesia presentation at your office
 Article in print media (please indicate ………………………)
 Advertisement in print media (please indicate ……………..)
 Radio (please indicate …………………………)
 Holland Education Fair (HEF) / European Higher Education
Fair (EHEF)
 Your institution
 Friends
 StuNed alumnus
 StuNed brochure/poster
 Nuffic Neso Indonesia office
 Others (please i ndicate …………….....................................…)
Where/How did you get the information about the study programme for which you apply?
Have you applied for StuNed Scholarship
Programme before?
(TICK ONLY ONE ITEM)
 List of courses on the Neso website
 Holland Education Fair (HEF) / European Higher Education
Fair (EHEF)
 Nuffic website
 Dutch Higher Education Institution website
 Friends
 Your institution
 Nuffic Neso Indonesia office
 Others indicate................................................................)
(please
 No
 Yes , year………… Program:

MA

SC

Tailor Made
Have you ever been awarded a scholarship?

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?
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7. STATEMENT BY THE 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 applicant’s 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)
Acknowledgement from Human Resource Division
Name and Signature (Affix Official Stamp) Date:
*)
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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;
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 for non- commercial purposes;
5. to abide by the rules and regulations governing the student visa and stay permit;
6. to fill in online end- of- course questionnaire;
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 whenever required;
9. 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;
10. not to hold another scholarship that would give any overlapping benefi t without Nuffic Neso Indonesia’s written approval.
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)
7