APPLICATION INFORMATION

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1 Menara Jamsostek 20th floor, Jl. Gatot Subroto no. 38, Jakarta p +62 (0) f +62 (0) 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 . 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 Failure to react to Nuffic Neso Indonesia s correspondence / within 48 hours can lead to cancellation of the scholarship. If at any time after awarding 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 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 changes. Apr May Jul 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 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 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 and Surabaya.

2 APPLICATION FORM MASTER PROGRAMME 2011 TO BE FILLED IN BY APPLICANT Please attach a recent photograph 3 x 4 name : Nahdya Maulina male female FOR OFFICIAL USE ONLY 1 : 2 : adik_nad@yahoo.com GPA: S S2 GPA MAX GPA MAX IBT / IELTS: 84 test date: Documents Y N 2 recent photographs Employer Statement Applicant's Declaration Admission Letter IBT/IELTS CV SK Original Diploma Translated Diploma Original Transcript Translated Transcript KTP or Passport chosen programme: university in NL: duration: Urban Planning and Management ITC Enschede 18 months Eligibility Y N Chosen Programme Admission Letter GPA Full Time / Part Time 2 years working exp. IELTS/IBT score Others employer: (name of institution) city: province: employed since: applicants position: Java Eco-Region Management Centre - Ministry of Environment Sleman DIY 01/01/2008 dd/mm/yyyy Staff of Spatial Planning Division Selection Partner MASP F / M Java / Outside Java Score Final Result Scholarship Award position held since: 01/01/2008 dd/mm/yyyy 2

3 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 PERSONAL INFORMATION All data exactly as they (will) appear in your passport! Name Nahdya Maulina Male Female Place/Date of Birth Place: Jakarta Date: August 16 th 1985 Marital Status Single Married Children Address Home Address Perumahan Griya Perwita Wisata Jl. Mawar No. 4, Ngaglik, Sleman, DIY Telephone / Fax / Mobile * obligatory Home *: Mobile Phone *: Passport number Nr. W Date of issue: 15/10/2010 Date of expiry: 15/10/2015 Parents address (or next of kin) Jl. Kedondong II No. 3 Rawamangun, Jakarta Timur Telephone / / elkareem@yahoo.com 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 ITC Master of Science Degree Course in Geo-information Science & Earth Observation for Urban Planning and Management Period of this programme From: 12/09/2011 Until: 08/03/2013 Duration : 18 months Name of contact person / Dr. Ir. M.H.P. (Mark) Zuidgeest zuidgeest@itc.nl Total tuition fee EUR 28, Minimum TOEFL / IELTS requirement for this programme PBT TOEFL 550 3

4 3. EDUCATIONAL RECORD a. Undergraduate Education Please enclose certified copies of relevant diplomas and transcripts Name of institution Place of Institution Field of study Institute Technology of Bandung Bandung West Java, Indonesia Architecture Diploma or degree obtained S-1 (or equivalent) Year of graduation 2007 GPA 3.30 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) Java Eco-Region Management Centre - Ministry of Environment Brief description of the company and the service it provides Java Eco-Region Management Centre is a part of Ministry of Environment that prevents, manages, and overcomes environmental issues in Regional Java. The vision of the institution is to establish a healthy and preserved environment for every human kind by improving the quality of the environment. Ministry of environment supervises all the missions and achievements of this instition. Address Jl. Ringroad Barat No. 100 Nogotirto, Gamping, Sleman DIY Telephone: Fax: Address: Employed Since 01/01/2008 (dd/mm/yyyy) Present position Staff Employment for 40 hours a week Describe your current duties and responsibilities Website: As a staff in spatial planning division in Java Eco-Region Management Centre, my responsibility is to make sure that the implementation of Strategic Environmental Assessment (SEA) in local spatial planning policies runs well by assisting the process of SEA and running the SEA clearing house website to update the spatial planning and SEA information for local government. This position held since 01/01/2008 (dd/mm/yyyy) 4

5 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. 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. The experiences dealing with flooding in Jakarta during my childhood life brought me to become more aware on environmental problems faced by Indonesian cities. Since then, I tried to live along with environment do something on our global environment. Finally, my passion for environment was fulfilled when I was accepted in the Ministry of Environment. The Ministry of Environment is now developing a new instrument, Strategic Environmental Assessment/SEA, which aimed at ensuring sustainable development considerations into the policy making process, including spatial planning. The spatial planning itself is now becoming seen as a strategic tool in mitigating climate change. However, after three years experiences in spatial planning and SEA, I found that those potential instruments are not yet effective in solving environmental problems. Part of the reasons is that Indonesia s human resources on this field are lacking and therefore no innovative ideas came out to improve the situation. By joining master program in urban planning and management at ITC, the Netherland, I hope I could contribute to the national efforts in developing more effective tools in dealing with environmental problems, including climate change. C. Describe in 100 words how the chosen study programme will benefit Indonesia in general. The role of Ministry of Environment is crucial in ensuring that spatial planning in Indonesia is environmentally sound and that spatial planning could become effective tool in mitigating climate change. Unfortunately, the Ministry is lacking of experts in this field. Study programme in urban planning and management with heavy load on environmental considerations would give many opportunities in improving the practice of spatial planning in Indonesia. By joining the programme, I will learn and share new things from different perspectives of countries in the world on how they carry out their spatial planning process and achieve their national development goals. Better spatial planning in Indonesia, I believe, would significantly improve our environment and mitigate climate change. 5

6 6. MISCELLANEOUS 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 strategy) Where/How did you get the information about the study programme for which you apply? Did you ever attend the StuNed Presentation in your region? Have you applied for StuNed Scholarship Programme before? (TICK ONLY ONE ITEM) Nuffic Neso Indonesia Website Nuffic Neso Indonesia Presentation at the Neso office (please indicate...) 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 (Supervisor) No Yes: University BAPPEDA/PEMDA YEAR: 2011 CITY: Depok No 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? Erasmus Mundus Regional Asia 6

7 7. STATEMENT BY THE EMPLOYER I, the undersigned, being authorised to supply the following particulars hereby certifies that Mr/Mrs/Miss.: Name Applicant: Nahdya Maulina is employed by our organisation Since: January 1 st, 2008 Department: Java Eco-Region Management Centre - Ministry of Environment Position: Staff of Spatial Planning Division for 40 hours a week Position held since: January 1 st, 2008 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): Urban Planning and Management Master of Science Degree Course in Geo-information Science & Earth Observation for Urban Planning and Management The challenge that we met in Ministry of Environment is the lack of Spatial Planning experts. For that reason, I support and encourage the candidate to continue her study majoring Urban Planning and Management under StuNed grant. I convinced that this institution will gain great benefits through her knowledge sharing 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? Yes, I do. I guarantee that Ms. Nahdya will continue to be employed by Java Eco-Region Management Centre - Ministry of Environment after she completes her study. Which position will be offered to the candidate after successful completion of her/his study? I will recommend her to take a strategic position on assisting SEA process in local government. Department: Java Eco-Region Management Centre - Ministry of Environment 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 : Java Eco-Region Management Centre - Ministry of Environment : Barlin, S.H., M.S. : Head Office Date : March, 2011 Place : Sleman Signature and official stamp : (please sign on materai) 7

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; 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; 10. not to hold another scholarship that would give any overlapping benefits without Nuffic Neso Indonesia s written approval. Furthermore: 11. 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. 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 : March, 2011 Name Place : Nahdya Maulina : Yogyakarta Signature : (please sign on materai) THE ORIGINAL APPLICATION FORM AND ITS ANNEXES TOGETHER WITH A COMPLETE COPY SHOULD BE SENT TO: Nuffic Neso Indonesia Menara Jamsostek 20 th Floor Jalan Jend. Gatot Subroto No.38 Jakarta