2016

PROFFER OF DARMASISWA SCHOLARSHIP PROGRAM

INTRODUCTION DARMASISWA INDONESIAN SCHOLARSHIP PROGRAM ACADEMIC YEAR 2015/2016 Darmasiswa RI program is a scholarship program offered by the Indonesian government to foreign students from countries which have diplomatic relationship with Indonesia to study Bahasa Indonesia, traditional arts and culture of Indonesia (Culinary, Tourism). The candidate is allowed to decide the higher institutions (universities) which carry out the program. DARMASISWA is a non-degree scholarship program offered to all foreign students from countries which have diplomatic relationship with Indonesia to study Bahasa Indonesia, arts, music, crafts and particular subject in 53 selected Indonesian Higher Education Institutions in different cities in Indonesia. This program organized by the Ministry of Education and Culture (MoEC) in Cooperation with Ministry of Foreign Affairs (MoFA). The main purpose of the Darmasiswa program is to increase and foster interest in Bahasa Indonesia and Indonesian culture among citizens from other countries. It has also been designed to enhance mutual understanding and provide stronger cultural link among different countries. The interest of international students to participate in this program keep increasing year by year, especially in the last five years as can been seen as the following table. Darmasiswa Scholarship Program is conducted in two schemes, i.e: I.

PROGRAM OFFERED 1 (One) Year Program Regular One Year program is one-year scholarship program offered to foreign students who would like to study Bahasa Indonesia, Arts, Culinary and Tourism in selected Indonesian Higher Education Institutions.

II. SCHEDULE OF PROGRAM 1. 2. 3. 4. 5.

Registration Selection Announcement Confirmation of Participating Submitting Flight Itinerary

22 December 2014 – 28 February 2015 1 March – 30 April 2015 8 May 2015 8 May – 8 June 2015 8 May – 26 July 2015 Page 1 of 4

PROFFER OF DARMASISWA SCHOLARSHIP PROGRAM

6. 7. 8.

Pre-departure briefing at July 2015 Indonesian Embassy/Consulate Orientation 28, 29, 30 August 2015 Commencement of Program September 2015 – July 2016

Note: Ministry of Education and Culture (MoEC), Ministry of Foreign Affairs (MoFA), Higher Education (HE)

III.

VISA ARRANGEMENT The Darmasiswa student is required to have a Social Visit Visa (VKSB) for 60 days issued by the Indonesian Embassy in the student’s country of residence. Upon arrival in Indonesia, the Darmasiswa student’s passport has to be submitted to the Bureau of Planning and International Cooperation, Ministry of Education and Culture, for necessary arrangements in obtaining recommendations of the State Secretariat and the Directorate General of Immigration, Ministry of Law and Human Rights. The students are prohibited to apply for Tourist Visa or On-Arrival Visa for study purpose.

IV.

COVERAGE OF SCHOLARSHIP Monthly allowance will be received by student is Rp 2.000.000,00 (two million rupiah). a. Living Cost b. Book Allowances c. Local Transport d. Medical/Health Care e. Pocket Money

: Rp. 1.200.000 : Rp. 200.000 : Rp. 200.000 : Rp. 200.000 : Rp. 200.000

The student is advised to bring enough money in US dollar for unexpected additional expenses in Indonesia. V.

QUALIFICATIONS OF STUDENTS Each student has to fulfill these requirements as the follows: a. Not more than 35 years of age b. Single status c. Must be a student as proven by recommendation letter from host university and recent transcript d. Completed secondary education or its equivalent e. In good health as proved by Medical Certificate f. Able to communicate in English or Bahasa Indonesia is required g. Have basic knowledge of the field you're applying for Page 2 of 4

PROFFER OF DARMASISWA SCHOLARSHIP PROGRAM

VI.

PROCEDURES The applicant should register through the following procedures: Prospective students are required to register at the Embassy / Consulate General in the country of origin of students, and for students who are not in the student's home country is not allowed to be registered through the Indonesian Embassy/Consulate General in the participating countries (non-citizenship).

VII. APPLICATION REQUIREMENTS Student must submit a complete application package that includes all the following items: a. Completed admission/application form b. Recommendation letter from Higher Education Institution c. Recommendation letter from Indonesian Embassy/Consulate General d. Copy of academic transcript e. Copy of certificates f. Copy of Health Certificate g. Copy passport valid at least 18 months from time of arrival in Indonesia. h. Curriculum vitae/resume i. Passport size color photograph (5 pieces) All documents must be submitted to Indonesian Embassy/Consulate General in residence to be selected; afterward Indonesian Embassy/Consulate General will send the selected documents to: Darmasiswa Scholarship Secretariat Head of Bureau of Planning and International Cooperation Secretariat General Ministry of Education and Culture C Building, 6th Floor Jalan Jenderal Sudirman, Senayan, Jakarta Telp./Fax. (+62-21) 5724707, 5738181 Website: http://darmasiswa.kemdikbud.go.id email: [email protected] VIII.

ACCOMODATION The Ministry of Education and Cultural doesn’t provide the accommodation for students.

Page 3 of 4

PROFFER OF DARMASISWA SCHOLARSHIP PROGRAM

IX.

ARRIVAL IN INDONESIA The Ministry of Education and Culture does not provide the return International airfare to Indonesia. We only provide the transportation from Jakarta to place of study; however the transportation from place of study to Jakarta will be carried out by students.

X.

HEALTH INSURANCE The Ministry of Education and Culture (MoEC) will not provide health insurance; therefore the students are expected to have the International insurance.

Bureau of Planning and International Cooperation, Ministry of Education and Culture

Page 4 of 4

LIST OF HIGHER EDUCATION INSTITUTIONS ORGANIZING OF DARMASISWA SCHOLARSHIP PROGRAM

NO

NAME OF HIGHER EDUCATION

ADDRESS

MAJOR

PROGRAM

Medan State University (UNMED)

Jl. Willem Iskandar Pasar V, Medan, 20221

Telp : (061) 6613365 Faks : (061) 6613319 Web : www.unimed.ac.id Email : [email protected]

Bahasa Indonesia

1 (one) Year

2

Andalas Univeristy (UNAND), Padang

Jl. Limau Manis, Kec. Pauh, Padang, Sumatera Barat, 25163

Telp : (0751)-71181, 71389, 777290 Faks : (0751)-71085, 777290 Web : www.unand.ac.id Email : [email protected] / [email protected]

Bahasa Indonesia

1 (one) Year

3

Jl. Bundo Kanduang 35, Indonesia Art Institute of Padang Panjang, Sumatera Padang Panjang Barat

Telp : (0752) 82077 Faks : (0752) 82803 Web : isi-padangpanjang.ac.id Email : [email protected]

Seni Budaya Melayu (Melayu Cultural Arts)

1 (one) Year

4

Sriwijaya University, (UNSRI) Palembang

Bahasa Indonesia

1 (one) Year

5

Telp : (0711) 515679 University of Bina Darma, Jl. Jenderal Ahmad Yani No.3, Faks : (0711) 518000 Palembang Palembang, 30264 Web : binadarma.ac.id Email : [email protected]

Bahasa Indonesia

1 (one) Year

Bahasa Indonesia

1 (one) Year

1

6

Lampung University (UNILA)

Telp : (0711) 580169 Jl. Raya Prabumulih, Indralaya Faks : (0711) 580644 OKI, Palembang Web : www.unsri.ac.id Email : [email protected]

Jl. Prof. Sumantri Brojonegoro No. 1 Bandar Lampung, 35145

Telp : (0721) 701609 Faks : (0721) 702767 Web : http://io.unila.ac.id Email : [email protected] / [email protected]

7

Univeristy of Indonesia (UI), Jakarta

Gedung X lt 1, LBI FIB UI, Fakultas Ilmu Pengetahuan Budaya, Kampus Universitas Indonesia, Depok 16424 Indonesia

8

Jakarta State University (UNJ)

Jl. Rawamangun Muka, 13220, Jakarta

9

Nasional University (UNAS), Jakarta

Telp : 021-780.6700 Ext. 168 Jl. Sawo Manila, Pejaten, Faks : 7802718-7802719 Pasar Minggu, Jakarta, 12520 Web : http//www.unas.ac.id Email : [email protected]

Bahasa Indonesia

1 (one) Year

LIA Institute of Foreign Language (STBA LIA)

Telp : 021-7918-1051 Faks : 021-7918-1057 Jl. Pengadengan Timur Raya Web : www.stbalia.ac.id No.3, Jakarta Selatan, 12270 Email : [email protected] / [email protected]

Bahasa Indonesia

1 (one) Year

Bahasa Indonesia

1 (one) Year

10

Telp : 021-7864075 Faks : 021-78849085 Web : www.lbifib.ui.ac.id Email : [email protected] / [email protected]

Bahasa Indonesia

1 (one) Year

Telp : (021) 4893982 Faks : (021) 4896977 Web : www.unj.ac.id Email : [email protected]

Bahasa Indonesia

1 (one) Year

University of Atmajaya Jl. Jenderal Sudirman No.51, 11 Jakarta (UNIKA Atmajaya Jakarta Selatan, 12930 Jakarta)

Telp : 57950476, 5703306 ext.637 Faks : (+62)215748811 Web : www.atmajaya.ac.id www.kui.atmajaya.ac.id Email : [email protected]

Sahid Institute of Tourism Jl. Kemiri no 22, Pondok 12 (STP Sahid Jakarta) Cabe, Pamulang, Jakarta

Telp : 021-7402329 / 021-7441083 Faks : 021-7428152 Web : stpsahid.ac.id Email : [email protected]

Telp : 021-7270034 Jakarta State Polytechnic Jl.Prof. Siwabessy,Kampus UI, Faks : 021-7270035 13 (PNJ) Depok. Web : www.pnj.ac.id Email : [email protected]

State Islamic University 14 (UIN) of Syarif Hidayatullah, Jakarta

Telp : 62217401472 Kampus 2 Jl. Kertamukti No.5 Faks : 622174700919 Pisangan Barat Ciputa Web : http://graduate.uinjkt.ac.id Cirendeu 15419 Email : [email protected]

Indonesian Tourism and 1 (one) Year Culinary

Bahasa Indonesia

1 (one) Year

Studi Agama Islam (Islamic Studies)

1 (one) Year

College of Computer and Jl. Perjuangan No. 10 B 15 Informatics Management Majasem Cirebon 45152 (STMIK IKMI Cirebon)

Telp : 0231 - 490481 Faks : 0231 - 490480 Web : ikmi.ac.id Email : [email protected]

Padjajaran University 16 (UNPAD) Bandung

Telp : +622284288846 Faks : +622284288894 Web : www.unpad.ac.id Email : [email protected]

Bahasa Indonesia

1 (one) Year

Telp : 022-2013313 Faks : 022-2013313 Web : www.upi.edu /www.oier.upi.edu Email : [email protected]

Bahasa Indonesia

1 (one) Year

Arts (Traditional Dance and Karawitan)

1 (one) Year

Bahasa Indonesia

1 (one) Year

Jl. Dipati Ukur No.35 Bandung, Jawa Barat

Education University of Jl. Dr. Setiabudi No.229, 17 Indonesia (UPI) Bandung Bandung, Jawa Barat

College of Indonesian 18 Arts (STSI) Bandung

Information Technology 1 (one) Year

Telp : (022) 7314982 (022) 7315435 Jl. Buah batu No 212 Bandung Faks : (022) 7303021 Jawa Barat Web : www.stsi-bdg.ac.id Email : [email protected]

Jl. Setiabudi 193 Bandung

Telp : 022-2021440 Faks : 022-2009267 Web : www.unpas.ac.id : [email protected] /[email protected]

Universitas Komputer 20 Indonesia (UNIKOM) Bandung

Jl. Dipati Ukur No.112-114 Bandung, Jawa Barat

Telp : (022) 2504119 Faks : (022) 2533754 Web : www.unikom.ac.id Email : [email protected]

Computer System

1 (one) Year

Universitas Telkom 21 (Telkom University) Bandung

Jl. Telekomunikasi, Terusan Buah Batu, Bandung

Telp : 022-7564108 Faks : 022-7565930 Web : www.telkomuniversity.ac.id Email : [email protected]

Arts (Textile Mode)

1 (one) Year

Institute of Technology 22 Bandung (ITB)

Jl. Ganesha 17, Bandung, 40132

Telp : 022-2504282 Faks : 022-2504282 Web : international.itb.ac.id Email : [email protected]

Bahasa Indonesia (for 1 semester); Fine Arts and Design; Architecture

1 (one) Year

19

University of Pasundan (UNPAS) Bandung

Email

Diponegoro University 23 (UNDIP) Semarang

Telp : (024) 7465402 Jl. Prof. Soedarto, SH Faks : (024) 7465402 Tembalang-Semarang 50275 Web : io.undip.ac.id Email : [email protected]

State University of 24 Semarang (UNNES)

Telp : (024) 8508004, 8508029, 8508081 Kampus Sekaran Gunungpati Faks : (024) 8508004, 8508082 Semarang, 50229 Web : www.unnes.ac.id Email : [email protected]

Soegijapranata Catholic University of Semarang 25 (UNIKA Soegijapranata, Semarang)

Jl. Pawiyatan Luhur IV/1 Bendan Duwur, Semarang, 50234

Telp : 024-8441555 (HUNTING) Faks : 024-8415429 Web : www.unika.ac.id Email : [email protected]

Bahasa Indonesia

1 (one) Year

Bahasa Indonesia and Batik Arts

1 (one) Year

Indonesian Traditional Herbal Medicine

1 (one) Year

Indonesia Art Institute of Jl. Parangtritis Km. 6,5 D.I 26 Yogyakarta (ISI Yogyakarta Yogyakarta)

Telp : (0274) 371233 Faks : (0274) 371233 Web : www.isi.ac.id Email : [email protected]

Bulaksumur, Caturtunggal, University of Gadjah 27 Depok, Sleman, Yogyakarta Mada (UGM) Yogyakarta 55281 Indonesia

Telp : (0274) 563974 Faks : (0274) 563974 Web : www.ugm.ac.id Email : [email protected]

Bahasa Indonesia

1 (one) Year

State University of 28 Yogyakarta (UNY)

Jl. Colombo No.1, Karangmalang, Yogyakarta, 55281

Telp : (0274) 586168 ext.318 Faks : (0274) 565500 Web : www.uny.ac.id Email : [email protected]

Bahasa Indonesia

1 (one) Year

University of Sanata 29 Dharma (USD) Yogyakarta

Mrican Tromol Pos 29 Yogyakarta, 55002

Telp : (0274) 513301, 515352 Faks : (0274) 562383 Web : www.usd.ac.id Email : [email protected]

Bahasa Indonesia

1 (one) Year

Telp : (0274) 563515 Faks : (0274) 564604 Web : www.oia.uad.ac.id Email : [email protected]

Bahasa Indonesia

1 (one) Year

Ahmad Dahlan University Jl. Kapas 9 Semaki, 30 (UAD) Yogyakarta

Arts (Dance, Karawitan, Batik, Etnomusicology, 1 (one) Year Paintings, Puppetry)

University of Atmajaya 31 Yogyakarta (UNIKA ATMAJAYA) Yogyakarta

Jl. Babarsari No. 44 Yogyakarta 55281

Teacher Training Center and Development of Art 32 and Culture (P4TK) Yogyakarta

Telp : (0274) 487711 Faks : (0274) 487729 Web : www.uajy.ac.id Email : [email protected]

Bahasa Indonesia

1 (one) Year

Telp : (+62) 274-895803, 274-895804, 274Jl. Kaliurang Km. 12,5, Klidon, 895805 Sukoharjo, Ngaglik, Sleman, Faks : (+62) 274-895804, 274-895805 Yogyakarta - 55581 Web : www.p4tksb-jogja.com Email : [email protected]

Arts (Dance, Karawitan, Fine Arts, Wood Crafting)

1 (one) Year

Indonesian Art Institute 33 (ISI) Surakarta

Telp : (0271) 647658 Jl. Ki Hajar Dewantara No.19, Faks : (0271) 646175 Kentingan, Jebres Surakarta Web : [email protected] Email : [email protected]

Arts (Dance, Karawitan, Fine Art, Batik, Etnomusicology)

1 (one) Year

University of Sebelas 34 Maret (UNS) Surakarta

Jl. Ir. Sutami no.36 A, Kentingan Surakarta 57126

Bahasa Indonesia

1 (one) Year

Muhammadiyah 35 University of Surakarta (UMS)

Telp : +62 (271) 717417 Jl. A. Yani Tromol Pos 1, Faks : +62 (271) 715448 Pabelan, Kartasura, Surakarta Web : http://www.ums.ac.id/ 57162 Email : [email protected]

Bahasa Indonesia

1 (one) Year

State University of 36 Malang (UM)

Telp : (0341) 551312 Jl. Semarang 5, Malang, Jawa Faks : (0341) 551312 Timur Web : www.um.ac.id : [email protected]

Bahasa Indonesia

1 (one) Year

Telp : (0341) 323214 Faks : (0341) 326019 Web : www.ikipbudiutomo.ac.id Email : [email protected]

Bahasa Indonesia

1 (one) Year

Telp : (0341) 464318/19 Faks : (0341) 460345 Web : www.umm.ac.id Email : iro.umm.ac.id/ [email protected]

Bahasa Indonesia

1 (one) Year

Teacher and Educational Institute of Budi Utomo Jl. Simpang Arjuna No.14B, 37 Malang (IKIP Budi Utomo Malang Malang)

38

Malang Muhammadiyah Jl. Raya Tlogo Mas No.246, University (UMM) Malang, Jawa Timur, 65114

Telp : (0271) 646 994, (0271) 636895 Faks : (0271) 646655 Web : io.uns.ac.id / uns.ac.id Email : [email protected]

Email

Vocational Education Development Center 39 (P4TK) Technology Malang

Telp : (0341) 491239, ext: 153/150 Jl. Teluk Mandar, Tromol Pos Faks : (0341) 491342 5, Arjosari - Malang 65102 Web : http://www.vedcmalang.com Email : [email protected]

Bahasa Indonesia

1 (one) Year

Malang State Polytechnic Jl. Soekarno Hatta No. 9 40 (POLINEMA) Malang

Telp : (0341) 404424, 404425 Faks : (0341) 404420 Web : http://www.polinema.ac.id Email : [email protected]

Bahasa Indonesia

1 (one) Year

Economic College (STIE) 41 of Malangkucecwara Malang

Jl. Terusan Candi Kalasan Malang, 65142

Telp : (0341) 491813 Faks : (0341) 495619 Web : www.stie-mce.ac.id Email : [email protected]

Bahasa Indonesia

1 (one) Year

State University of 42 Surabaya (UNESA)

Jl. Ketintang, Wonokromo, Surabaya, Jawa Timur

Telp : (031) 8287725 Faks : (031) 8287725 Web : www.unesa.ac.id Email : [email protected]

Bahasa Indonesia

1 (one) Year

Airlangga University 43 (UNAIR) Surabaya

Jl. Airlangga No. 4-6, Surabaya, Jawa Timur

Telp : (031) 5914042 Faks : (031) 5955582 Web : www.unair.ac.id Email : [email protected]

Bahasa Indonesia

1 (one) Year

Jl. Sutorejo 59 Surabaya

Telp : (031) 3811966 Faks : (031) 3811966 Web : http://www.um-surabaya.ac.id Email : [email protected]

Bahasa Indonesia

1 (one) Year

Telp : (031) 8439040 Faks : (031) 8492583 Web : petra.ac.id Email : [email protected], [email protected]

Bahasa Indonesia

1 (one) Year

Bahasa Indonesia

1 (one) Year

Muhammadiyah 44 University of Surabaya (UNMUH Surabaya)

45

46

Petra Christian University Jl. Siwalankerto 121-131, Surabaya Jawa Timur 60236

University of Surabaya (UBAYA)

Telp : (031) 2981300 Faks : (031) 2981301 Jl. Raya Kalirungkut, Surabaya Web : http://international.ubaya.ac.id Email : [email protected]/ [email protected]

Sepuluh November 47 Institute of Technology (ITS) Surabaya

Kampus ITS Sukolilo, Surabaya, 60111

Telp : (031) 5923411 Faks : (031) 5923411 Web : international.its.ac.id Email : [email protected]

Indonesian Art Institute 48 (ISI) Denpasar

Jl. Nusa Indah, Denpasar, Kota Denpasar, Bali 80235

Telp : (0361) 227316, 236100 Faks : (0361) 236100 Web : www.isi-dps.ac.id Email : [email protected]

Bahasa Indonesia

1 (one) Year

Arts (Dance, Karawitan, Fine Arts)

1 (one) Year

Jl. Kampus Bukit Jimbaran, Bali

Telp : (0361) 704845 Faks : (0361) 701907 Web : www.unud.ac.id Email : [email protected] / [email protected]

Bahasa Indonesia

1 (one) Year

Ganesha Education 50 University (UNDIKSHA) Singaraja, Bali

JL. Ahmad Yani, No. 67, Banyuasri, Buleleng, Bali

Telp : (0361) 22570 Faks : (0361) 25735 Web : undiksha.ac.id Email : [email protected] / [email protected]

Bahasa Indonesia

1 (one) Year

Politechnic of Bali 51 (POLIBALI)

Telp : (0361) 701981 Kampus Bukit Jimbaran, Kuta Faks : (0361) 701128 Selatan-Badung, Bali Web : www.pnb.ac.id Email : [email protected]

Indonesian Tourism

1 (one) Year

49

University of Udayana (UNUD) Bali

Teacher and Educational Institute of Saraswati 52 Jl. Pahlawan No.2, Bali (IKIP Saraswati) Tabanan, Bali

Telp : (0361) 814909 Faks : (0361) 814909 Web : ikipsaraswatitabanan.com Email : [email protected]

Bahasa Indonesia

1 (one) Year

Mulawarman University 53 (UNMUL) Kalimantan Timur

Telp : (0541) 741118 Faks : (0541) 732870,747479 Web : www.unmul.ac.id Email : [email protected] / [email protected]

Bahasa Indonesia

1 (one) Year

Telp : (0411) 866972 Faks : (0411) 860132 Web : www.unismuh.ac.id Email : [email protected]

Bahasa Indonesia

1 (one) Year

Rektorat Kampus Gunung Kelua, Jl. Kuaro, Samarinda, Kalimantan Timur 75119

Makasar Muhammadiyah Jl. Sultan Alauddin No. 259, 54 University (UNIMUH) Makassar, Sulawesi Selatan Makassar 90221

Bureau of Planning and International Cooperation Ministry of Education and Culture

MINISTRY OF EDUCATION AND CULTURE THE GOVERNMENT OF THE REPUBLICOF INDONESIA Jalan Jenderal Sudirman – Senayan, Jakarta Phone/Fax: (+6221) 5724707, 5711144 ext. 2610 Website: darmasiswa.kemdikbud.go.id Email: [email protected]

DARMASISWA SCHOLARSHIP PROGRAM APPLICATION FORM

A. PERSONAL INFORMATION Family Name:_________________________________________________________________ Name: Mr/Mrs/Ms ____________________________________________________________ Citizenship: ___________________________________________________________________

affix photo here

Religion: ______________________________________________________________________

4 X 6 cm

Place and date of birth: _______________________________________________________ Passport Number: __________________________________Validity of _________________ Mailing Address: ____________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________ (Home)/Cell-phone: _____________________ (Office): ______________________ Fax: _______________________ Email: ___________________________________ Marital status:

Single

Married (approved by copy of marriage certificate)

Do you have a husband/wife or any dependants? (Please give details of name, relationship and date of birth)

No

Name

Relationship

Where do you prefer for stay?

(If you choose homestay, please fill out the homestay application form)

Homestay

Boarding House

Dormitory Page 1 of 5

DARMASISWA SCHOLARSHIP APPLICATION FORM Person to be notified in your country and in Indonesia in case of emergency: In your country

In Indonesia

Name: _________________________________________

Name: _________________________________________

Address: _______________________________________

Address: _______________________________________

Home/Cell Phone: ______________________________

Home/Cell Phone: _____________________________

Relationship:____________________________________

Relationship:____________________________________

B. ACADEMIC BACKGROUND** University/Institute Attended after High School

Years Attended

Degree Obtained/Expected

From

(incl. Field of Study)

To

GPA

____________________________________________________

_________________________

__________________________________ _________

____________________________________________________

_________________________

__________________________________ _________

____________________________________________________

_________________________

__________________________________ _________

Academic Referees

Please provide the names and address of at least 2 persons you’ve asked to forward confidential references to the scholarship office. One of these referees must be either your proposed Chief Supervisor or a member of academic staff at the institution at where you obtained the entry qualification. Those references (ideally on letterhead paper) must be attached.

Title and Name of Referee 1: _________________________________________________________________________ Address:_____________________________________________________________________________________________ Phone:_______________________________________________Email:__________________________________________

Title and Name of Referee 2: _________________________________________________________________________ Address:_____________________________________________________________________________________________ Phone:_______________________________________________Email:__________________________________________ Language: State proficiency Fair-Good-Advance Skills No

Language

1

Bahasa Indonesia

2

English

3

Other:

Speaking

Understanding

Writing

Page 2 of 5

DARMASISWA SCHOLARSHIP APPLICATION FORM C. PROPOSED PROGRAM AND FIELD OF STUDY** (Check one program and subject of study)

1. Put a checklist (√ ) in the box below with the following description: a. If you choose the first choice and you don’t pass the selection, it is not acceptable to follow the Darmasiswa Scholarship Program. b. If you choose the second choice, it means that you would be ready to be placed at any universities in accordance with Ministry of Education and Culture. c. If you choose both choices, the first choice is not pass, and then you would be ready placed at any universities in accordance with Ministry of Education and Culture.

First Choice (Your own choice) Place of Study

:________________________________________________________________

Subject of Study

:________________________________________________________________

Second Choice (Ready to be placed to any other university)

2. Outline your proposed field of study and indicate the practical use to be made of this study. If you are acquainted with the possibilities of study offered in Indonesia, list of institutes or projects you propose to study or specific course you wish to attend. _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ (attach additional pages) Page 3 of 5

DARMASISWA SCHOLARSHIP APPLICATION FORM

D. PROFESSIONAL BACKGROUND**

List your work experience since university graduation. Start with the most current one. Dates (To–From) Position Name of Institution Responsibility (indicate month)

_____________ ____________________ ___________________________ ____________________________________ _____________ ____________________ ___________________________ ____________________________________ _____________ ____________________ ___________________________ ____________________________________ E.

SOCIAL AND COMMUNITY INVOLVEMENT**

List professional, societal, fraternities or other organizations in which you now hold membership or in which you have been active in the past. (Indicate if you have held an elective office): Year

Position/Organization

Responsibility

_____________ _________________________________________________ ____________________________________ _____________ _________________________________________________ ____________________________________ _____________ _________________________________________________ ____________________________________ _____________ _________________________________________________ ____________________________________ If you have ever traveled or lived outside Indonesia, please specify dates, countries and purpose** Dates

Country

Purpose

____________________ ___________________________ ___________________________________________________ ____________________ ___________________________ ___________________________________________________ ____________________ ___________________________ ___________________________________________________ ____________________ ___________________________ ___________________________________________________

F.

HOW DO YOU LEARN ABOUT DARMASISWA SCHOLARSHIP PROGRAM

Newspaper ads Friend Website Other: __________________________________________________________________ If you are currently applying for other scholarship programs, please specify program and status of your application Name of Program

Type of Program Applied

Time Period

__________________________________

__________________________________

_____________________________

__________________________________

__________________________________ _____________________________ Page 4 of 5

DARMASISWA SCHOLARSHIP APPLICATION FORM DECLARATION 

I hereby certify that the information I have provided on this application form and in any attached materials is accurate and true to the best of my knowledge and belief, and I agree to notify Ministry of Education and Culture (MoEC) of any change in the above information or of any further information that might affect my eligibility for consideration as a prospective recipient of the Darmasiswa Scholarship award.



I understand that by completing this application form there is no assurance that I will be awarded a grant.



I understand that grant funds are not sufficient to cover travel or support for my family and I will make necessary arrangements for the living expenses in Indonesia.



I will not change either subject or place of study prior or upon arrival in Indonesia.



I will not involve myself in any political activities or doing criminals during my study in Indonesia.



I will not undertake any work for profit or earn living during my study in Indonesia.



I will not involve with any drug traffic: active user or drug-seller.

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I will not do and perform immoral acts.

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I will not travel out of Indonesia during the academic period and not travel out of Indonesia more than once.

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I will not allowed to bring the family during the study period even though at my own expense

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I will not allow performing activities of a certain ideologies or indoctrination.

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I fully responsible for my own luggage/goods if its lost prior or upon arrival in Indonesia. Have them in my hands custody.



I have to refrain myself from being pregnant and being involved in drug traffic and abuses.



I accept to be sent back to my country if I violate the said regulations and the stay permit regulation in Indonesia.



I have to abide by the regulation of the government of Indonesia and as well as the Host University.

Signature: ______________________________________ Date: ____________________________________________ Note: **Please attach additional pages if necessary.

THIS FORM IS TO BE FILLED OUT COMPLETELY AND ACCURATELY. WE REGRET INCOMPLETE APPLICATION WILL NOT BE CONSIDERED. Page 5 of 5