APPLICATION INFORMATION MASTER PROGRAMME

Transcription

1 Menara Jamsostek 20 th Floor, Jl. Gatot Subroto No. 38, Jakarta P F APPLICATION INFORMATION MASTER PROGRAMME 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 . 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 May 2015 and the result will be announced to the applicants at the latest by end of June Failure to react to Neso s correspondence/ 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. 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 minimum 80 or `International English Language Testing System Test Report Form (IELTS Report Form) minimum score 6; (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 Copy SK for government officials or kontrak kerja for others; Legalized copies of original diplomas and transcripts; Copy of KTP or copy of passport One recent photograph (3x4; colour) The closing date is 15 March 2015 Applications received after the closing date and incomplete application will not be processed. Two complete sets of application form should be submitted. Completion in stages is not possible. C. SELECTION PROCEDURE Mar-Apr 2015 May 2015 Jul 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. Selected candidates will be notified through a letter via , 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. Awardees will be invited for a pre-departure briefing in Jakarta.

2 APPLICATION FORM MASTER PROGRAMME 2015 TO BE FILLED IN BY APPLICANT Name : 1 : 2 : AGUSTIN CAPRIATI Female Agustin.capriati@yahoo.co.id Agustin.capriati@gmail.com FOR OFFICIAL USE ONLY Documents Y N Application form Employer statement Applicant's declaration Admission letter IBT/IELTS GPA: S S2 GPA MAX GPA MAX CV SK Original diploma IBT / IELTS: 6.0 Test date: Original transcript KTP or Passport Chosen Programme: University in NL: Aquaculture and Marine Resource Management Wageningen University Eligibility Y N 2 years working exp. Full time / Part time Employer Statement SK GPA IELTS/IBT Duration: 24 months Study Abroad Admission Letter Chosen Programme Tuition Fee StuNed/NFP awardee Employer: (Name of Institution) Kelompok Nelayan Ikan Hias-Samudera Bakti Selection Score City: Indonesia 2015 EKN 2015 GMF Province: East Java 2015 JOJ 2015 MIB Employed Since: 11/02/2013 (dd/mmm/yyyy) Total score Applicant Position: Research and Development Final Result Y / N Position Held Since: 11/02/2013 (dd/mmm/yyyy) Scholarship Award 2

3 APPLICATION FORM MASTER PROGRAMME 2015 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 PERSONAL INFORMATION All data exactly as they (will) appear in your passport! Name AGUSTIN CAPRIATI Place / Date of Birth SEKAYU / 02/08/1992 Marital Status Single Children Yes No Address 1. agustin.capriati@yahoo.co.id 2. agustin.capriati@gmail.com Address Komplek Griya Randik Blok B.1-02 City: SEKAYU Province: SOUTH SUMATERA Telephone Home: - Mobile: Emergency Contact (or Next of Kin) NURHASANAH Relationship: MOTHER - Tel: DESIRED MASTER PROGRAMME FOR WHICH YOU HAVE BEEN ADMITTED Please enclose the admission letter from the University or Institution. University Name WAGENINGEN UNIVERSITY Study Programme AQUACULTURE AND MARINE RESOURCES MANAGEMENT Program Period From: 01/09/2015 to 01/09/2017 Duration: 24 months Contact Person MARIAME GADA ssc@wur.nl Total Tuition Fee EUR15,800 Minimum TOEFL/IELTS EDUCATIONAL BACKGROUND a. Undergraduate Education Please enclose certified copies of relevant diplomas and transcripts University or Institution BRAWIJAYA UNIVERSITY Country: INDONESIA Study Programme FISHERIES RESOURCE UTILIZATION Award Obtained Bachelor Year of graduation: 2014 GPA 3.69 b. Postgraduate Education or Training Please enclose certified copies of relevant diplomas, degrees, certificates and transcripts. University or Institution BOGOR AGRICULTURAL UNIVERISTY Country: INDONESIA Study Programme Award Obtained 4. ENGLISH PROFICIENCY Please enclose copy of your Test Result. MARINE SCIENCE AND TECHNOLOGY From (03/11/2014) to (13/11/2014) TRAINING CAREER (MST-CAREER) Master Other Intensive Year of graduation GPA Career Training Test Name IELTS Test Score 6.0 Test Date: 14/02/2014 3

4 4. PRESENT EMPLOYMENT Employer Department/Directorate Present Position IKHWAN ARIEF KELOMPOK NELAYAN IKAN HIAS SAMUDERA BAKTI (ORNAMENTAL FISH ASSOCIATION) RESEACRH AND DEVELOPMENT STAFF This Position Held Since 01/01/2012 Employed Since From: 01/02/2012 To: 01/02/2014 Employment For Describe Your Current Duties And Responsibilities 20 HOURS A WEEK Researcher of destructive toward non-destructive usage, coral trasnplantation and marine ecotourism, representative of project report, treasurer tasks and arrange field documentation and report. Address City: Indonesia Phone: Fax: - Province: East Java merdekamerdeka@ymail.com Website: - Brief description of Your Employer Research and development program, strengthen knowledge in friendly environment usage in order to create pleasant environment including marine ecotourism, coral transplantation and friendly fish catch. Moreoever, received an honour and fund from Directorate of General and Higher Education of Indonesia. 5. MOTIVATION STATEMENT The statement should be typewritten and composed only by the applicant him/herself. No. Criteria Explanation A. Explain in 100 words the relevance of the chosen study programme to your personal and career development A group of fishing house-hold depend their livelihood from ornamental fish. Potassium cyanide together with hookah compressor is commonly practiced to stunt the target fishes those hide inside coral reef complex. In 2010, they observed a significant drop to the catch and cannot compesated by the price. Fishermen were frequently having close contact with university students who regulargy visited the village for field practical. Fishermen gained awareness from outreach through information sharing in the field facilitated by fisheries senior students. I my self usually visited Bangsring for several times. After some mini research and investigation, the possible cause of the drop were the fish population being oo low, degradation of the most potential habitat (coral reef) or combination of both result in very low recovery. Follow through investigating project that is clear that human resources who has high capability and basis in fishery management is need, indeed. By taking fisheries master degree, I strongly believed that I can obtain a good understanding and experiences of how to manage marine and fisheries resources based on environmentally approach. 4

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. Master programme of Aquaculture and Marine Resources Management is relevant for current development in my position. I have been working for current association of ornamental fish in East Java which has no researcher and developer yet well. As consequences of this, high quality of staff will be needed to support and enhance the number of grader worker. MSc Programme of Aquaculture and Marine Resources Management need an evolvement to broaden place and need involvment of great researcher. C. Describe in 100 words how the chosen study programme will benefit Indonesia in general. Since I worked in research and development program in Bangsring, Banyuwangi, East Java, Indonesia and several volunteer program in marine environment, I proposed to continue to next level which include facilitate Indonesia to obtain sustainabel management in marine and fisheries in general and in marine ecotourism and marine pollution in particular. Marine resources management and environmental quality and governance is suitable with some phenomenon in high number of destructive thing in marine ecosystem. This subject can be used as recommendation for government to impose regulation on managing fisheries and marine exploration, exploitation and management. 6. MISCELLANEOUS 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 indicate... ) 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 (please indicate...) No Yes, year Program: MA SC Tailor Made Have you ever been awarded a scholarship? Yes No 5

6 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? PT. Oil Spill Combat Team (OSCT) Indonesia Funding research in oil spill area in Indonesia No, I am not. 6

7 7. STATEMENT BY THE EMPLOYER I, the undersigned, being authorised to supply the following particulars hereby certifies that: Name of Applicant: Agustin Capriati Employed Since: 01/02/2012 Department/Directorate: Kelompok Nelayan Ikan Hias Samudera Bakti (Ornamental Fish Association) Current Position: Research and Development Staff for 20 hours a week Position Held Since: 01/01/2012 And is applying for a StuNed scholarship to follow a master programme in The Netherlands in the field of / name of the study programme: Aquaculture and Marine Resources Management Dutch Higher Education Institution (University) in the Netherlands : Wageningen University Please explain fully why the master programme is important to your organisation (and to the applicant s work in the future) : Our department has mission to improve reseacrh and development capacity to manage resouces that we have. I encourage Agustin Capriati to pursue her education in higher level. Hence, after finishing her education, she may come back and bring new ideas and fresh atmosphere, become expert and expertise in her field which will bring advantage in our department in particularly and Indonesia generally. 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? Assistant of Research and Development Department: Kelompok Nelayan Ikan Hias Samudera Bakti (Ornamental Fish Association) 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*: Director of Kelompok Nelayan Ikan Hias Samudera Bakti (Ornamental Fish Association) address: merdekamerdeka@ymail.com Date: 19 March 2015 Place: Bangsring, Banyuwangi, East Jav Signature and Official Stamp (Obligatory): (please sign on materai (obligatory) Acknowledgement from Human Resource Division Name and Signature (Affix Official Stamp) *) the lowest level of employer authorisation should be at least echelon 2 command or the equivalent level in the Ministry or Institution. Failure upon providing sufficient authorisation will lead to disqualification of application. 7 Date:

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; 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 benefit 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 : 31 March 2015 Name Place : Agustin Capriati : Bogor 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