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GENERAL GUIDE
DARMASISWA PROGRAM FOR FOREIGN STUDENTS
ACADEMIC YEAR 20122013
Oarmasiswa is an Indonesian scholarship offer for students offoreign nationals from friendly
countries to study Bahasa Indonesia (the Indonesian language) traditional music traditional
dance the art of handicraft tourism culinary and other specific study program in the participating higher institutions
The aim of the program is to propagate Indonesian language and culture among friendly
nations This programme also functions as a mean of cultur~1 diplomacy as well as a mean
ofreciprocity for similar programs offered by other friendly nations for Indonesian students
Darmasiswa is a nonmiddotdegree program While participating in the program the participants
are not allowed to take any job do any research andor participate in any political activities
I PROGRAM OFFERED
1 INDONESIAN DARMASISWAPROGRAM -1 (ONE) VEAR REGULAR This program grants scholarship for foreign students offriendly nations to study
Bahasa Indonesia Indonesian localtraditional languages traditional music
traditional dance the art of handicraft culinary tourism and other specific
study program in the participating higher education institutions for 1 (one) year
2 INDONESIAN DARMASISWA PROGRAM - 6 (SIX) MONTHS REGULAR
This program grants scholarship for foreign students of friendly nations to study
Bahasa Indonesia and other specific study program in the participating higher
education institutions for 6 (six) months
3 SUMMER CQURSEPROGRAM - 3 THREE) MONTHS R~GULAR This program grants scholarship for foreign students of friendly nations to study
a specific study prOiram in the participating higher education institutions (lSI
Yogyakarta ITB IPB UNESA UNAIR UIN Jakarta UNUO UGM dan UI) for 3
(three) months
II RIGHTS AND DUTIES
1 RIGHTS OF THE PARnOPANTS
a Receive scholarst1ip every month b) Getting assistance in finding accommodation house for rent from the
chosen higher education institution
b 6 (six) months regular program would start on the beginning of August
2012 until January 2013
c 1 (one) year regular program would start on the beginning of August
2012 until July 2013
10Specificaltyfor participantswho would like to study in Universitas Indonesia
(UI the study schedule would start by the End ofJuly 2012
IV VISA
The visa for participating in this program is a 60 days Visa Kunjungan Sosial
Budaya (VKS8) which could be attained through the nearest Indonesian Embassy
or Consulate in the country where the participants live Further the visa would
be converted according to the study period to receive a stay permit after the
participants arrive in Indonesia through the National Secretariat of the Republic
of Indonesia and the General Directorate of Immigration the Department of Law
and Human Rights
The participants are not allowed to use Tourist Visa or OnmiddotArrival Visa to study
in Indonfisia since this could cause problem when applying for a stay permit in
Indonesta
V sOtOLARSHIP GRANTED
The amount of scholarship received by the participants is Rp 2000000 (two
million Rupiah) per month with details as follow
a living Cost Rp 1200000shy
b Text Books Cost Rp 200000shy
c Local Transport Rp 200000shy
d Health Cost Rp 200000shy
e Allowance Rp 200000
Since the amount is not enough for everydays needs the participants are
strongly encouraged to take along additional money in USD in order to ease the
exchange with Rupiah
2 Direkur Diplomasl Publlk
Direktorat JenderaUnformasl dan Diplomas Publik
Kementerian Luar Negeri
Jalan Taman PeJambon No6
Jakarta -Indonesia
Telepon (021) 3813480 Faks (021)3858035
VIII THE TRAVELUNG OF PARTICIPANTS TO INDONESIA
The government of the Republic of Indonesia in this The Bureau of Foreign
Cooperation and Planning Department of Education and Culture (Depdikbud)
does not providetravelling fees from and to the participants respective G~untiY
Oepdikbud would cover-a one way ticket froni Jakarta-to the province where the
higher education institution is located while the returning ticket would be the
obliged to the participants
IX HEALTH INSURANCE
Oepdikbud does not provide insurance Perticipants are expected to have
international insurance prior to departureto Indonesia
The Bureau of Foreign Cooperation and Planning Department of Education and
Culture
XI LIST OF UNiVERSmES AND COLLEGES ORGANIZING IN THE REGULAR 1 (ONE) YEAR AND REGULAR 8 (SIX)MONTH ~ROGRAM
NO HfGHSR
EDUCATION INSmUnON
ADDRESS MAJOR PROGRAM
1 Medan State middotUnlversily (UNIMED
Witlem Iskandar Psr V Medan Estate Medan Telp(Q61 )6~13365 Fax (061) 6613319 Web wwwunimedac1d
Bahasa Indonesia (Indonesian Language)
- ~e9ular 1 Year - Regular eMonth
2 Anifalas Unhiersfty (UNAND) PADANG
Rektoral UnandKampus Manis Padang Telp (07~1) 71303 Fax (0751) 71985 Web WNWunandac1d
Bahasalndonesfa ( Indonesian Language)
- Regular 1 Year - Regular 6 Month
_3 Indqnesian Art Institute qf Padang Panjang (lSi Padang Panjang)
Bund~ Kanduang 35 Padang Panjang Sumatera Baral Telp (0752) 820n Fax (0752) 82803 Web wwwlsl-
IDadangpaniangae1d
- Karawitan (Tredit~nal MUsic) - Sen Tali (Dance) -Senl Kriya (Handicraft)
- Regular 1 Year
4 Srtiijaya -University UNSRI Palembang
RayaPrabumulih Indralaya OKI Palembang Telp 0711) 580357 Web wwwunsriacid
BahasaJndonesla (indonesian Language)
- Regurar 1 Yeaf - Regular 6 Month
5 Univen1ty of Bina Danna Palembllng
JI Jenderal Ahmad Vanl No 24 Palembang30264 Telpbull (0711)7080181 Fax (0711)513018 Web WVNIblnadannaacidmiddot
Bahasa Indonesia Indonesian Language)
- Regular 1 Yeal - Regular 6 Month
5 Lampung Unlerslty (UNltA)
Profl Dr SumantJ BrojonegoroNo 1 Bandsr Lampung 35145 Telp (0121) 701609 Fax (0721) 702787 WebwwwuniIBac1d
Bahasalndonesia [Indonesian Language)
- Regular 1 Year bull Regular 6 Month
6 University of fndonesia (UI) Jakarta
Kampus UI Depok 16424 Jawa Barat Teip (021) 7270009 7S63f2B 7863529 7B64075 FalC O21 7270038 Web WWYIuiacid
BahBsalndonesfa (InC1oneslan Language)
-
bull Regular 1 Year - Regular 6 Month
1 Jakarta State University (UJt
RawaMsngun MUkai JKT 13220 1felpfFax (021) 4893982 Web VtWWunJacid
Banasalndqnesia (ll1doneslan Langu~)
bull Regular 1 Year - Regular 6 Month
8 Nasfonal University (UNASbullbull Jakarta
Sawo Manila rajat Pasar Mlnggu Jaka$ 12520 Telp (021)7808700 Fex (021) 7802718119 Web wwwunasacld
Bahasa Indonesia Jndoneslan Language)
- Regular 1 Year bull Regular e Monttl
2
18 State University of Semarang (UNNESJ
Kampus UNNES Gedung H Sekaren Gunungpatl T~lp (024) 8508004 Web wwwunnesac1d
bull Sahasalndonesla (Indonesian Language) bull Senl ~upa (Fin Art) - Sem Kriya (HSlldlcraft) - Serll Muslk (Music Tradtlonal bull Senl Tan (TradltJon~1 Dance) bull Senl Batik (Batik Art)
- RegUlar 1 Year bull Regular SMonth
19 Teacher and Educational Institutemiddotof PGRI Semarang (lKIP PGRI Semarang)
Kampus I rLontatNo 1 (Sldodadl Tlmur) Semarang KarnpLlS II Llngga Raya No 1Semaraog Telp (024) 8448Z17 83163n Fax (024) 8448217 Web wwwtIdppgrtsmrgnet
Bahasa Indonesia (lndimeslan language)
- Regular Year - ReguJar 6 Month
20 SoogtJapranata Catflollc UniverSity ofSemarang (UNIKA SoegijBpranata Semarang
JL Pawiyatan Luhur IVli Bendan Ouwur Semarang middot50234 Telp (024) 8441555 Fax (024f84452656 8415429 Website wwwuniksacid
bull Indonesian Traditional Herbal Medicine
bull Eillerpreneurship and Social Responsbilily
- Regular 1 Year - Regular 6 MOnth
21 UniVersity of Jenderal Soedirman Purwokerto
JI Prof Or HR Boenjamln 708 PO BGX 15 Purwoker1o Telp (0281) 63529294 Fax (0281) 631602
Bahasa Indonesia (IJ1dOn~ian language)
bull Regular 1 Year ~ Regular EI Month
22 lndonesian Art Institute of Yogyakarta (lSI Yogyakarta
Parangtrltis Km 6~ 01 YOgyakar1a ielpJFax (O274311233 Webslfe httpwwwislacd
- SenlKriya (Handicraft) - SeniTari Tredslonal (Traditiona Dance) - Karawitan (Traditional Music) -Fotografi Photography)
- Regular 1 Year
23 University of Gad)ahMada (UGM) Yogyakarta
Bulaksumu-r 01 Yogyakarra Telp(0274) 563974 Website httpwNvvugmacld
Bahasa Indonesia (Indonesian language)
bull Regular 1Year -Regular B Month
24 Stale University of Yogyakarta (UNY)
Karangmalang 01 Yogyakaria -Telp (0274) 586168 ext 316 Fax (0274) 565500 Website httpwwwunyacJd
Ir
Bahasa rdonesla (Indonesian Language)
- Regular 1 Year bull Regular 6 Month
4
32 State University of Surabaya NO 6 Bahasa rndonesia - Regular 1 Year Malang Malang - Jawa Tlmur (Indonesian ~ Regular 6Month (UMrMalang Tefp1 Fax (0341) 551312 L8nguege)
Websitewwwmalang8cld
33 Teachrand Sirnpang Arjuno 14 B Regular 1 Year Educational
- BahasaJn~esia Maang (lndQnesfan - RegtJlar 6 Month
Institute of Budi Teip (0341) 326019 Language) UtOmoMlln9 (IKIP 323214 -Senl Budl Utomo Fax (0341) 326019 (Art) Malang) Websitlil
wwwJk~budlutomoacld
34 Polytechnic of Jalan Veleran PO BOX 04 Bahasa Indonetia - Regular 1 Year Malang Malang 65145 (Indonesfan - Regular 6 Month (POLINEMA) TelpiFax (0341) 562158 Language)
Website (tIWN poltek-malangacid
35 Malang Ja~n Raya Ttogomas24B Bahasa Inacnesia - Regular 1 Year Muhammadiyah Maiang (IndOnesian - Regular 6 Month University (UMM Telp (0341)46431819 Language)
Faits (0341) 460782 I 460345 Website WWWummacid
36 VoCational Jalan Teluk MaIIdar AljOsari Bahasa Indonesia - Regular 1 Year Education Tromol Pos 5 Malang 65102 (I ndonesian Development TeJp (0341) 491239 Language) Center (P4lK) Website Teknol9il1 Malena httpwwwvedc ma~rtgcom
37 University of Jalan Kalimantan 37 Bahasa Indonesia - Regular 1 Year Jamber Kampus TegarSoto (Indotl8slan - Regular 6 Month (OJ) Language)
T~lp (0331) 337422 F~(0331337422
~ember68121
Email relctorunejecJd Web wwwuneJac1d Kampus IKlP Surabaya Bahasa Indonesia38 Slale University of -Regular 1 Year
Surabaya (Indonesian bull Regular 6 Month (UNESA)
~tintang Language)
Telp (031) 8290357 Surabaya - Jaws Timur
Website httDilwwwunesascld
39 Ainangga Kanpus C Mulyorejo bull Regular 1 Yaar University
- Bahasafndonesla Surabaya e011 6 bull Farmaey (Herb) - Regular eMonltl
(UNAIR) Surabaya Telp (031) 5914042 5912546 Fax (031) 5961841 Website httpilwwwunalracld
40 - Regular 1 Year University of
SUtorejo No 59 Surabaya Bahasa IndonesiaMuham~dlYllh Telp (031) 3811966 (Indonesian - Regular 6 Month
Surabaya (UNMUH language) Surabaya)
Fax (031) 3813096 WebSite httpwINwacid
I
6
~ 49 Mulawarman Kamp1 Unmul ~Jnung Bahasa Indonesia - Regular 1Year
UnIversity Kelu8 Kotak Pas 1068 (Indonesian bull Regular 6 Month CUNMUL) Samarinda languag~) Kalimantan Timur Telp(0541) 748698
Fax (0541) 747479 WebWWWunmulac1d
50 Makasar SultanmiddotAlaudfn No 259 Bahasa Indonesia bull R~ular 1 Yeai Muhammadlyah MakaSSal (Indonesian - Regular 6 Month UnIVersity Telp (041 1881593 41nguage) (UNISMUH Fax (0411) 865588 Makasal) Web WWWunlsmuhaeid
51 UnlVerty of Jalan Perintis Kemerdekaao Bahasa Indonesia - Regular 1 Year Hasanuddln KM 10 Makasser (Indonesian - Regular 6 Month Makasar (UNHAS) Teip (0411) 584002 588200 Language)
Fax (0411) 58518B Web wwwunhasscid
52 Sam Ratulangi ~Bahaaa Indonesia ~ Regular 1 Year University Manado
KamPUB UntalBshu (IndonesianMenado North Sulawesi bull Regular 6 Month
(UNSRAT) Telp (0431) 863785 863886 language) bull Summer 3 Monthmiddot Fall (0431) a22568 middotPerlkanan amp web wwwunsrataQid Kelautan (Flsherfes
and Marine) - PerUinlan jAgricuHureJ
bull Regular 1Year Komputer
Jt Oipatl Ukur 102 118 bullTeknr~ Komputer53 Universitas (Computer
Indonasla Bandung4Q132
Technology) (UNIKOIiI) Bandung
Tep (022) 250 3J)54 bull Sistemlnfonnasi
Webwwwunlkornscid Fax (022) 253 3754
(Information System) bull Akunlansl
I(Accounting)
Bureau of Planning and Il)femationalCooperation Ministry of Educatlonand Culture
I l
i
8
9 University of Udayana (UNUD) Bali
Komplek Kampus Jlmbaran Denpas8r Telp (0361) 701954 Fax (0361)701907 Website httpwwwunudacld
Southeast Asia EconomY
bull Hospitality amI resort design
bull Southeasl Asian Vernacular
Bureau of Planning and Intematlonal Cooperation Mini$try of EducatiDn and Culture
10
---------------------
-------------------
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MtNISTRY qF EDUCATI~ ANP CULTURE THE GOVERNMENT OF THE REPUBLlC OF INDONESIA
JalaB JeDdera Sudinn~D - SenaYln J A K ART A lO70
TelpJFu (62 - 01) 5724707 573J181) 5711144 Ext 1610 Website darmasiswakqmdikaasgoid E-mail darmasiswaJdilyahoocom
APPUCATION FORM SCHOLARS8IP FORDARMASISWA RI PROGRAMmiddot
INSTRUCTIONS
Please answer each questions clearly and completely Type or print in ink Read carefully and follow all directions Ifyou more spac~ attaoh additional pages of the same size Submit the completed fonn duly signed in lhroo copies to the Indonesian EmbassyIDipJomaticRef)resentative in your country
A PERSONAL DETAILS
I a Family name
b First name
2 Date of birth affix photo here
J Plllce ofhirth 4x6cm
4 MalclFemale
5 Nationality
6 Religion
7 Paspor Number Validity of
8 E-maH
9 a Mariml status 0 Single a Married b Do you have a husbandiwife or any dependan~
(Please give details ofnaine relationship and date of birth)
NO NAME RELATIONSHIP AGE
I
------ --- ------ ----- ------- - -- ~--
bull
D PROPOSED PROGRAM AND FlELD OF STIJDV (to be answered as detailed as possible)
I Program aD Regular I Year
bD Summer 6 Month
c 0 Regular) Month
Frst Chpice
Place ofStudy
Subject ofStudy
SecondCholu
Place ofStudy
Subject ofStudy
2 Outline your proposed field ofSludy and indicate the pracdcal use to be made of this study Ifyou are acquainted with the possibilities ofstudy offered in Indonesia iisntle institutes or projects you propose to study or the specific course you wish to attend
(Additional pa~lerfor mnre information)
)
--------~-~--~
List any siggificant publication you have written (do not attach)
l-ave you applied for any other scholarship DYes o No
SU~~lb________________________________________________~_
Organiz8rion
Period from ___________ to-------------__
Travel (List period spent away from YOllr home country)
Country visited
(~ OTHERS Experience abroad
No C0untry
~
Reason for ~isit or residel)cc abroad
Purpose
-
Dat~s
Year
-shy
w
shy
5
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Lf)nafliII3il1~LLftUfltl~~~1t1~LVlfllVltll~uu8t-laquoVlu1~tIn1EltmflHmj Mekong Institute - New
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GENERAL GUIDE
DARMASISWA PROGRAM FOR FOREIGN STUDENTS
ACADEMIC YEAR 20122013
Oarmasiswa is an Indonesian scholarship offer for students offoreign nationals from friendly
countries to study Bahasa Indonesia (the Indonesian language) traditional music traditional
dance the art of handicraft tourism culinary and other specific study program in the participating higher institutions
The aim of the program is to propagate Indonesian language and culture among friendly
nations This programme also functions as a mean of cultur~1 diplomacy as well as a mean
ofreciprocity for similar programs offered by other friendly nations for Indonesian students
Darmasiswa is a nonmiddotdegree program While participating in the program the participants
are not allowed to take any job do any research andor participate in any political activities
I PROGRAM OFFERED
1 INDONESIAN DARMASISWAPROGRAM -1 (ONE) VEAR REGULAR This program grants scholarship for foreign students offriendly nations to study
Bahasa Indonesia Indonesian localtraditional languages traditional music
traditional dance the art of handicraft culinary tourism and other specific
study program in the participating higher education institutions for 1 (one) year
2 INDONESIAN DARMASISWA PROGRAM - 6 (SIX) MONTHS REGULAR
This program grants scholarship for foreign students of friendly nations to study
Bahasa Indonesia and other specific study program in the participating higher
education institutions for 6 (six) months
3 SUMMER CQURSEPROGRAM - 3 THREE) MONTHS R~GULAR This program grants scholarship for foreign students of friendly nations to study
a specific study prOiram in the participating higher education institutions (lSI
Yogyakarta ITB IPB UNESA UNAIR UIN Jakarta UNUO UGM dan UI) for 3
(three) months
II RIGHTS AND DUTIES
1 RIGHTS OF THE PARnOPANTS
a Receive scholarst1ip every month b) Getting assistance in finding accommodation house for rent from the
chosen higher education institution
b 6 (six) months regular program would start on the beginning of August
2012 until January 2013
c 1 (one) year regular program would start on the beginning of August
2012 until July 2013
10Specificaltyfor participantswho would like to study in Universitas Indonesia
(UI the study schedule would start by the End ofJuly 2012
IV VISA
The visa for participating in this program is a 60 days Visa Kunjungan Sosial
Budaya (VKS8) which could be attained through the nearest Indonesian Embassy
or Consulate in the country where the participants live Further the visa would
be converted according to the study period to receive a stay permit after the
participants arrive in Indonesia through the National Secretariat of the Republic
of Indonesia and the General Directorate of Immigration the Department of Law
and Human Rights
The participants are not allowed to use Tourist Visa or OnmiddotArrival Visa to study
in Indonfisia since this could cause problem when applying for a stay permit in
Indonesta
V sOtOLARSHIP GRANTED
The amount of scholarship received by the participants is Rp 2000000 (two
million Rupiah) per month with details as follow
a living Cost Rp 1200000shy
b Text Books Cost Rp 200000shy
c Local Transport Rp 200000shy
d Health Cost Rp 200000shy
e Allowance Rp 200000
Since the amount is not enough for everydays needs the participants are
strongly encouraged to take along additional money in USD in order to ease the
exchange with Rupiah
2 Direkur Diplomasl Publlk
Direktorat JenderaUnformasl dan Diplomas Publik
Kementerian Luar Negeri
Jalan Taman PeJambon No6
Jakarta -Indonesia
Telepon (021) 3813480 Faks (021)3858035
VIII THE TRAVELUNG OF PARTICIPANTS TO INDONESIA
The government of the Republic of Indonesia in this The Bureau of Foreign
Cooperation and Planning Department of Education and Culture (Depdikbud)
does not providetravelling fees from and to the participants respective G~untiY
Oepdikbud would cover-a one way ticket froni Jakarta-to the province where the
higher education institution is located while the returning ticket would be the
obliged to the participants
IX HEALTH INSURANCE
Oepdikbud does not provide insurance Perticipants are expected to have
international insurance prior to departureto Indonesia
The Bureau of Foreign Cooperation and Planning Department of Education and
Culture
XI LIST OF UNiVERSmES AND COLLEGES ORGANIZING IN THE REGULAR 1 (ONE) YEAR AND REGULAR 8 (SIX)MONTH ~ROGRAM
NO HfGHSR
EDUCATION INSmUnON
ADDRESS MAJOR PROGRAM
1 Medan State middotUnlversily (UNIMED
Witlem Iskandar Psr V Medan Estate Medan Telp(Q61 )6~13365 Fax (061) 6613319 Web wwwunimedac1d
Bahasa Indonesia (Indonesian Language)
- ~e9ular 1 Year - Regular eMonth
2 Anifalas Unhiersfty (UNAND) PADANG
Rektoral UnandKampus Manis Padang Telp (07~1) 71303 Fax (0751) 71985 Web WNWunandac1d
Bahasalndonesfa ( Indonesian Language)
- Regular 1 Year - Regular 6 Month
_3 Indqnesian Art Institute qf Padang Panjang (lSi Padang Panjang)
Bund~ Kanduang 35 Padang Panjang Sumatera Baral Telp (0752) 820n Fax (0752) 82803 Web wwwlsl-
IDadangpaniangae1d
- Karawitan (Tredit~nal MUsic) - Sen Tali (Dance) -Senl Kriya (Handicraft)
- Regular 1 Year
4 Srtiijaya -University UNSRI Palembang
RayaPrabumulih Indralaya OKI Palembang Telp 0711) 580357 Web wwwunsriacid
BahasaJndonesla (indonesian Language)
- Regurar 1 Yeaf - Regular 6 Month
5 Univen1ty of Bina Danna Palembllng
JI Jenderal Ahmad Vanl No 24 Palembang30264 Telpbull (0711)7080181 Fax (0711)513018 Web WVNIblnadannaacidmiddot
Bahasa Indonesia Indonesian Language)
- Regular 1 Yeal - Regular 6 Month
5 Lampung Unlerslty (UNltA)
Profl Dr SumantJ BrojonegoroNo 1 Bandsr Lampung 35145 Telp (0121) 701609 Fax (0721) 702787 WebwwwuniIBac1d
Bahasalndonesia [Indonesian Language)
- Regular 1 Year bull Regular 6 Month
6 University of fndonesia (UI) Jakarta
Kampus UI Depok 16424 Jawa Barat Teip (021) 7270009 7S63f2B 7863529 7B64075 FalC O21 7270038 Web WWYIuiacid
BahBsalndonesfa (InC1oneslan Language)
-
bull Regular 1 Year - Regular 6 Month
1 Jakarta State University (UJt
RawaMsngun MUkai JKT 13220 1felpfFax (021) 4893982 Web VtWWunJacid
Banasalndqnesia (ll1doneslan Langu~)
bull Regular 1 Year - Regular 6 Month
8 Nasfonal University (UNASbullbull Jakarta
Sawo Manila rajat Pasar Mlnggu Jaka$ 12520 Telp (021)7808700 Fex (021) 7802718119 Web wwwunasacld
Bahasa Indonesia Jndoneslan Language)
- Regular 1 Year bull Regular e Monttl
2
18 State University of Semarang (UNNESJ
Kampus UNNES Gedung H Sekaren Gunungpatl T~lp (024) 8508004 Web wwwunnesac1d
bull Sahasalndonesla (Indonesian Language) bull Senl ~upa (Fin Art) - Sem Kriya (HSlldlcraft) - Serll Muslk (Music Tradtlonal bull Senl Tan (TradltJon~1 Dance) bull Senl Batik (Batik Art)
- RegUlar 1 Year bull Regular SMonth
19 Teacher and Educational Institutemiddotof PGRI Semarang (lKIP PGRI Semarang)
Kampus I rLontatNo 1 (Sldodadl Tlmur) Semarang KarnpLlS II Llngga Raya No 1Semaraog Telp (024) 8448Z17 83163n Fax (024) 8448217 Web wwwtIdppgrtsmrgnet
Bahasa Indonesia (lndimeslan language)
- Regular Year - ReguJar 6 Month
20 SoogtJapranata Catflollc UniverSity ofSemarang (UNIKA SoegijBpranata Semarang
JL Pawiyatan Luhur IVli Bendan Ouwur Semarang middot50234 Telp (024) 8441555 Fax (024f84452656 8415429 Website wwwuniksacid
bull Indonesian Traditional Herbal Medicine
bull Eillerpreneurship and Social Responsbilily
- Regular 1 Year - Regular 6 MOnth
21 UniVersity of Jenderal Soedirman Purwokerto
JI Prof Or HR Boenjamln 708 PO BGX 15 Purwoker1o Telp (0281) 63529294 Fax (0281) 631602
Bahasa Indonesia (IJ1dOn~ian language)
bull Regular 1 Year ~ Regular EI Month
22 lndonesian Art Institute of Yogyakarta (lSI Yogyakarta
Parangtrltis Km 6~ 01 YOgyakar1a ielpJFax (O274311233 Webslfe httpwwwislacd
- SenlKriya (Handicraft) - SeniTari Tredslonal (Traditiona Dance) - Karawitan (Traditional Music) -Fotografi Photography)
- Regular 1 Year
23 University of Gad)ahMada (UGM) Yogyakarta
Bulaksumu-r 01 Yogyakarra Telp(0274) 563974 Website httpwNvvugmacld
Bahasa Indonesia (Indonesian language)
bull Regular 1Year -Regular B Month
24 Stale University of Yogyakarta (UNY)
Karangmalang 01 Yogyakaria -Telp (0274) 586168 ext 316 Fax (0274) 565500 Website httpwwwunyacJd
Ir
Bahasa rdonesla (Indonesian Language)
- Regular 1 Year bull Regular 6 Month
4
32 State University of Surabaya NO 6 Bahasa rndonesia - Regular 1 Year Malang Malang - Jawa Tlmur (Indonesian ~ Regular 6Month (UMrMalang Tefp1 Fax (0341) 551312 L8nguege)
Websitewwwmalang8cld
33 Teachrand Sirnpang Arjuno 14 B Regular 1 Year Educational
- BahasaJn~esia Maang (lndQnesfan - RegtJlar 6 Month
Institute of Budi Teip (0341) 326019 Language) UtOmoMlln9 (IKIP 323214 -Senl Budl Utomo Fax (0341) 326019 (Art) Malang) Websitlil
wwwJk~budlutomoacld
34 Polytechnic of Jalan Veleran PO BOX 04 Bahasa Indonetia - Regular 1 Year Malang Malang 65145 (Indonesfan - Regular 6 Month (POLINEMA) TelpiFax (0341) 562158 Language)
Website (tIWN poltek-malangacid
35 Malang Ja~n Raya Ttogomas24B Bahasa Inacnesia - Regular 1 Year Muhammadiyah Maiang (IndOnesian - Regular 6 Month University (UMM Telp (0341)46431819 Language)
Faits (0341) 460782 I 460345 Website WWWummacid
36 VoCational Jalan Teluk MaIIdar AljOsari Bahasa Indonesia - Regular 1 Year Education Tromol Pos 5 Malang 65102 (I ndonesian Development TeJp (0341) 491239 Language) Center (P4lK) Website Teknol9il1 Malena httpwwwvedc ma~rtgcom
37 University of Jalan Kalimantan 37 Bahasa Indonesia - Regular 1 Year Jamber Kampus TegarSoto (Indotl8slan - Regular 6 Month (OJ) Language)
T~lp (0331) 337422 F~(0331337422
~ember68121
Email relctorunejecJd Web wwwuneJac1d Kampus IKlP Surabaya Bahasa Indonesia38 Slale University of -Regular 1 Year
Surabaya (Indonesian bull Regular 6 Month (UNESA)
~tintang Language)
Telp (031) 8290357 Surabaya - Jaws Timur
Website httDilwwwunesascld
39 Ainangga Kanpus C Mulyorejo bull Regular 1 Yaar University
- Bahasafndonesla Surabaya e011 6 bull Farmaey (Herb) - Regular eMonltl
(UNAIR) Surabaya Telp (031) 5914042 5912546 Fax (031) 5961841 Website httpilwwwunalracld
40 - Regular 1 Year University of
SUtorejo No 59 Surabaya Bahasa IndonesiaMuham~dlYllh Telp (031) 3811966 (Indonesian - Regular 6 Month
Surabaya (UNMUH language) Surabaya)
Fax (031) 3813096 WebSite httpwINwacid
I
6
~ 49 Mulawarman Kamp1 Unmul ~Jnung Bahasa Indonesia - Regular 1Year
UnIversity Kelu8 Kotak Pas 1068 (Indonesian bull Regular 6 Month CUNMUL) Samarinda languag~) Kalimantan Timur Telp(0541) 748698
Fax (0541) 747479 WebWWWunmulac1d
50 Makasar SultanmiddotAlaudfn No 259 Bahasa Indonesia bull R~ular 1 Yeai Muhammadlyah MakaSSal (Indonesian - Regular 6 Month UnIVersity Telp (041 1881593 41nguage) (UNISMUH Fax (0411) 865588 Makasal) Web WWWunlsmuhaeid
51 UnlVerty of Jalan Perintis Kemerdekaao Bahasa Indonesia - Regular 1 Year Hasanuddln KM 10 Makasser (Indonesian - Regular 6 Month Makasar (UNHAS) Teip (0411) 584002 588200 Language)
Fax (0411) 58518B Web wwwunhasscid
52 Sam Ratulangi ~Bahaaa Indonesia ~ Regular 1 Year University Manado
KamPUB UntalBshu (IndonesianMenado North Sulawesi bull Regular 6 Month
(UNSRAT) Telp (0431) 863785 863886 language) bull Summer 3 Monthmiddot Fall (0431) a22568 middotPerlkanan amp web wwwunsrataQid Kelautan (Flsherfes
and Marine) - PerUinlan jAgricuHureJ
bull Regular 1Year Komputer
Jt Oipatl Ukur 102 118 bullTeknr~ Komputer53 Universitas (Computer
Indonasla Bandung4Q132
Technology) (UNIKOIiI) Bandung
Tep (022) 250 3J)54 bull Sistemlnfonnasi
Webwwwunlkornscid Fax (022) 253 3754
(Information System) bull Akunlansl
I(Accounting)
Bureau of Planning and Il)femationalCooperation Ministry of Educatlonand Culture
I l
i
8
9 University of Udayana (UNUD) Bali
Komplek Kampus Jlmbaran Denpas8r Telp (0361) 701954 Fax (0361)701907 Website httpwwwunudacld
Southeast Asia EconomY
bull Hospitality amI resort design
bull Southeasl Asian Vernacular
Bureau of Planning and Intematlonal Cooperation Mini$try of EducatiDn and Culture
10
---------------------
-------------------
t bull
laquo bull
MtNISTRY qF EDUCATI~ ANP CULTURE THE GOVERNMENT OF THE REPUBLlC OF INDONESIA
JalaB JeDdera Sudinn~D - SenaYln J A K ART A lO70
TelpJFu (62 - 01) 5724707 573J181) 5711144 Ext 1610 Website darmasiswakqmdikaasgoid E-mail darmasiswaJdilyahoocom
APPUCATION FORM SCHOLARS8IP FORDARMASISWA RI PROGRAMmiddot
INSTRUCTIONS
Please answer each questions clearly and completely Type or print in ink Read carefully and follow all directions Ifyou more spac~ attaoh additional pages of the same size Submit the completed fonn duly signed in lhroo copies to the Indonesian EmbassyIDipJomaticRef)resentative in your country
A PERSONAL DETAILS
I a Family name
b First name
2 Date of birth affix photo here
J Plllce ofhirth 4x6cm
4 MalclFemale
5 Nationality
6 Religion
7 Paspor Number Validity of
8 E-maH
9 a Mariml status 0 Single a Married b Do you have a husbandiwife or any dependan~
(Please give details ofnaine relationship and date of birth)
NO NAME RELATIONSHIP AGE
I
------ --- ------ ----- ------- - -- ~--
bull
D PROPOSED PROGRAM AND FlELD OF STIJDV (to be answered as detailed as possible)
I Program aD Regular I Year
bD Summer 6 Month
c 0 Regular) Month
Frst Chpice
Place ofStudy
Subject ofStudy
SecondCholu
Place ofStudy
Subject ofStudy
2 Outline your proposed field ofSludy and indicate the pracdcal use to be made of this study Ifyou are acquainted with the possibilities ofstudy offered in Indonesia iisntle institutes or projects you propose to study or the specific course you wish to attend
(Additional pa~lerfor mnre information)
)
--------~-~--~
List any siggificant publication you have written (do not attach)
l-ave you applied for any other scholarship DYes o No
SU~~lb________________________________________________~_
Organiz8rion
Period from ___________ to-------------__
Travel (List period spent away from YOllr home country)
Country visited
(~ OTHERS Experience abroad
No C0untry
~
Reason for ~isit or residel)cc abroad
Purpose
-
Dat~s
Year
-shy
w
shy
5
I
~ I bull
h I
GENERAL GUIDE
DARMASISWA PROGRAM FOR FOREIGN STUDENTS
ACADEMIC YEAR 20122013
Oarmasiswa is an Indonesian scholarship offer for students offoreign nationals from friendly
countries to study Bahasa Indonesia (the Indonesian language) traditional music traditional
dance the art of handicraft tourism culinary and other specific study program in the participating higher institutions
The aim of the program is to propagate Indonesian language and culture among friendly
nations This programme also functions as a mean of cultur~1 diplomacy as well as a mean
ofreciprocity for similar programs offered by other friendly nations for Indonesian students
Darmasiswa is a nonmiddotdegree program While participating in the program the participants
are not allowed to take any job do any research andor participate in any political activities
I PROGRAM OFFERED
1 INDONESIAN DARMASISWAPROGRAM -1 (ONE) VEAR REGULAR This program grants scholarship for foreign students offriendly nations to study
Bahasa Indonesia Indonesian localtraditional languages traditional music
traditional dance the art of handicraft culinary tourism and other specific
study program in the participating higher education institutions for 1 (one) year
2 INDONESIAN DARMASISWA PROGRAM - 6 (SIX) MONTHS REGULAR
This program grants scholarship for foreign students of friendly nations to study
Bahasa Indonesia and other specific study program in the participating higher
education institutions for 6 (six) months
3 SUMMER CQURSEPROGRAM - 3 THREE) MONTHS R~GULAR This program grants scholarship for foreign students of friendly nations to study
a specific study prOiram in the participating higher education institutions (lSI
Yogyakarta ITB IPB UNESA UNAIR UIN Jakarta UNUO UGM dan UI) for 3
(three) months
II RIGHTS AND DUTIES
1 RIGHTS OF THE PARnOPANTS
a Receive scholarst1ip every month b) Getting assistance in finding accommodation house for rent from the
chosen higher education institution
b 6 (six) months regular program would start on the beginning of August
2012 until January 2013
c 1 (one) year regular program would start on the beginning of August
2012 until July 2013
10Specificaltyfor participantswho would like to study in Universitas Indonesia
(UI the study schedule would start by the End ofJuly 2012
IV VISA
The visa for participating in this program is a 60 days Visa Kunjungan Sosial
Budaya (VKS8) which could be attained through the nearest Indonesian Embassy
or Consulate in the country where the participants live Further the visa would
be converted according to the study period to receive a stay permit after the
participants arrive in Indonesia through the National Secretariat of the Republic
of Indonesia and the General Directorate of Immigration the Department of Law
and Human Rights
The participants are not allowed to use Tourist Visa or OnmiddotArrival Visa to study
in Indonfisia since this could cause problem when applying for a stay permit in
Indonesta
V sOtOLARSHIP GRANTED
The amount of scholarship received by the participants is Rp 2000000 (two
million Rupiah) per month with details as follow
a living Cost Rp 1200000shy
b Text Books Cost Rp 200000shy
c Local Transport Rp 200000shy
d Health Cost Rp 200000shy
e Allowance Rp 200000
Since the amount is not enough for everydays needs the participants are
strongly encouraged to take along additional money in USD in order to ease the
exchange with Rupiah
2 Direkur Diplomasl Publlk
Direktorat JenderaUnformasl dan Diplomas Publik
Kementerian Luar Negeri
Jalan Taman PeJambon No6
Jakarta -Indonesia
Telepon (021) 3813480 Faks (021)3858035
VIII THE TRAVELUNG OF PARTICIPANTS TO INDONESIA
The government of the Republic of Indonesia in this The Bureau of Foreign
Cooperation and Planning Department of Education and Culture (Depdikbud)
does not providetravelling fees from and to the participants respective G~untiY
Oepdikbud would cover-a one way ticket froni Jakarta-to the province where the
higher education institution is located while the returning ticket would be the
obliged to the participants
IX HEALTH INSURANCE
Oepdikbud does not provide insurance Perticipants are expected to have
international insurance prior to departureto Indonesia
The Bureau of Foreign Cooperation and Planning Department of Education and
Culture
XI LIST OF UNiVERSmES AND COLLEGES ORGANIZING IN THE REGULAR 1 (ONE) YEAR AND REGULAR 8 (SIX)MONTH ~ROGRAM
NO HfGHSR
EDUCATION INSmUnON
ADDRESS MAJOR PROGRAM
1 Medan State middotUnlversily (UNIMED
Witlem Iskandar Psr V Medan Estate Medan Telp(Q61 )6~13365 Fax (061) 6613319 Web wwwunimedac1d
Bahasa Indonesia (Indonesian Language)
- ~e9ular 1 Year - Regular eMonth
2 Anifalas Unhiersfty (UNAND) PADANG
Rektoral UnandKampus Manis Padang Telp (07~1) 71303 Fax (0751) 71985 Web WNWunandac1d
Bahasalndonesfa ( Indonesian Language)
- Regular 1 Year - Regular 6 Month
_3 Indqnesian Art Institute qf Padang Panjang (lSi Padang Panjang)
Bund~ Kanduang 35 Padang Panjang Sumatera Baral Telp (0752) 820n Fax (0752) 82803 Web wwwlsl-
IDadangpaniangae1d
- Karawitan (Tredit~nal MUsic) - Sen Tali (Dance) -Senl Kriya (Handicraft)
- Regular 1 Year
4 Srtiijaya -University UNSRI Palembang
RayaPrabumulih Indralaya OKI Palembang Telp 0711) 580357 Web wwwunsriacid
BahasaJndonesla (indonesian Language)
- Regurar 1 Yeaf - Regular 6 Month
5 Univen1ty of Bina Danna Palembllng
JI Jenderal Ahmad Vanl No 24 Palembang30264 Telpbull (0711)7080181 Fax (0711)513018 Web WVNIblnadannaacidmiddot
Bahasa Indonesia Indonesian Language)
- Regular 1 Yeal - Regular 6 Month
5 Lampung Unlerslty (UNltA)
Profl Dr SumantJ BrojonegoroNo 1 Bandsr Lampung 35145 Telp (0121) 701609 Fax (0721) 702787 WebwwwuniIBac1d
Bahasalndonesia [Indonesian Language)
- Regular 1 Year bull Regular 6 Month
6 University of fndonesia (UI) Jakarta
Kampus UI Depok 16424 Jawa Barat Teip (021) 7270009 7S63f2B 7863529 7B64075 FalC O21 7270038 Web WWYIuiacid
BahBsalndonesfa (InC1oneslan Language)
-
bull Regular 1 Year - Regular 6 Month
1 Jakarta State University (UJt
RawaMsngun MUkai JKT 13220 1felpfFax (021) 4893982 Web VtWWunJacid
Banasalndqnesia (ll1doneslan Langu~)
bull Regular 1 Year - Regular 6 Month
8 Nasfonal University (UNASbullbull Jakarta
Sawo Manila rajat Pasar Mlnggu Jaka$ 12520 Telp (021)7808700 Fex (021) 7802718119 Web wwwunasacld
Bahasa Indonesia Jndoneslan Language)
- Regular 1 Year bull Regular e Monttl
2
18 State University of Semarang (UNNESJ
Kampus UNNES Gedung H Sekaren Gunungpatl T~lp (024) 8508004 Web wwwunnesac1d
bull Sahasalndonesla (Indonesian Language) bull Senl ~upa (Fin Art) - Sem Kriya (HSlldlcraft) - Serll Muslk (Music Tradtlonal bull Senl Tan (TradltJon~1 Dance) bull Senl Batik (Batik Art)
- RegUlar 1 Year bull Regular SMonth
19 Teacher and Educational Institutemiddotof PGRI Semarang (lKIP PGRI Semarang)
Kampus I rLontatNo 1 (Sldodadl Tlmur) Semarang KarnpLlS II Llngga Raya No 1Semaraog Telp (024) 8448Z17 83163n Fax (024) 8448217 Web wwwtIdppgrtsmrgnet
Bahasa Indonesia (lndimeslan language)
- Regular Year - ReguJar 6 Month
20 SoogtJapranata Catflollc UniverSity ofSemarang (UNIKA SoegijBpranata Semarang
JL Pawiyatan Luhur IVli Bendan Ouwur Semarang middot50234 Telp (024) 8441555 Fax (024f84452656 8415429 Website wwwuniksacid
bull Indonesian Traditional Herbal Medicine
bull Eillerpreneurship and Social Responsbilily
- Regular 1 Year - Regular 6 MOnth
21 UniVersity of Jenderal Soedirman Purwokerto
JI Prof Or HR Boenjamln 708 PO BGX 15 Purwoker1o Telp (0281) 63529294 Fax (0281) 631602
Bahasa Indonesia (IJ1dOn~ian language)
bull Regular 1 Year ~ Regular EI Month
22 lndonesian Art Institute of Yogyakarta (lSI Yogyakarta
Parangtrltis Km 6~ 01 YOgyakar1a ielpJFax (O274311233 Webslfe httpwwwislacd
- SenlKriya (Handicraft) - SeniTari Tredslonal (Traditiona Dance) - Karawitan (Traditional Music) -Fotografi Photography)
- Regular 1 Year
23 University of Gad)ahMada (UGM) Yogyakarta
Bulaksumu-r 01 Yogyakarra Telp(0274) 563974 Website httpwNvvugmacld
Bahasa Indonesia (Indonesian language)
bull Regular 1Year -Regular B Month
24 Stale University of Yogyakarta (UNY)
Karangmalang 01 Yogyakaria -Telp (0274) 586168 ext 316 Fax (0274) 565500 Website httpwwwunyacJd
Ir
Bahasa rdonesla (Indonesian Language)
- Regular 1 Year bull Regular 6 Month
4
32 State University of Surabaya NO 6 Bahasa rndonesia - Regular 1 Year Malang Malang - Jawa Tlmur (Indonesian ~ Regular 6Month (UMrMalang Tefp1 Fax (0341) 551312 L8nguege)
Websitewwwmalang8cld
33 Teachrand Sirnpang Arjuno 14 B Regular 1 Year Educational
- BahasaJn~esia Maang (lndQnesfan - RegtJlar 6 Month
Institute of Budi Teip (0341) 326019 Language) UtOmoMlln9 (IKIP 323214 -Senl Budl Utomo Fax (0341) 326019 (Art) Malang) Websitlil
wwwJk~budlutomoacld
34 Polytechnic of Jalan Veleran PO BOX 04 Bahasa Indonetia - Regular 1 Year Malang Malang 65145 (Indonesfan - Regular 6 Month (POLINEMA) TelpiFax (0341) 562158 Language)
Website (tIWN poltek-malangacid
35 Malang Ja~n Raya Ttogomas24B Bahasa Inacnesia - Regular 1 Year Muhammadiyah Maiang (IndOnesian - Regular 6 Month University (UMM Telp (0341)46431819 Language)
Faits (0341) 460782 I 460345 Website WWWummacid
36 VoCational Jalan Teluk MaIIdar AljOsari Bahasa Indonesia - Regular 1 Year Education Tromol Pos 5 Malang 65102 (I ndonesian Development TeJp (0341) 491239 Language) Center (P4lK) Website Teknol9il1 Malena httpwwwvedc ma~rtgcom
37 University of Jalan Kalimantan 37 Bahasa Indonesia - Regular 1 Year Jamber Kampus TegarSoto (Indotl8slan - Regular 6 Month (OJ) Language)
T~lp (0331) 337422 F~(0331337422
~ember68121
Email relctorunejecJd Web wwwuneJac1d Kampus IKlP Surabaya Bahasa Indonesia38 Slale University of -Regular 1 Year
Surabaya (Indonesian bull Regular 6 Month (UNESA)
~tintang Language)
Telp (031) 8290357 Surabaya - Jaws Timur
Website httDilwwwunesascld
39 Ainangga Kanpus C Mulyorejo bull Regular 1 Yaar University
- Bahasafndonesla Surabaya e011 6 bull Farmaey (Herb) - Regular eMonltl
(UNAIR) Surabaya Telp (031) 5914042 5912546 Fax (031) 5961841 Website httpilwwwunalracld
40 - Regular 1 Year University of
SUtorejo No 59 Surabaya Bahasa IndonesiaMuham~dlYllh Telp (031) 3811966 (Indonesian - Regular 6 Month
Surabaya (UNMUH language) Surabaya)
Fax (031) 3813096 WebSite httpwINwacid
I
6
~ 49 Mulawarman Kamp1 Unmul ~Jnung Bahasa Indonesia - Regular 1Year
UnIversity Kelu8 Kotak Pas 1068 (Indonesian bull Regular 6 Month CUNMUL) Samarinda languag~) Kalimantan Timur Telp(0541) 748698
Fax (0541) 747479 WebWWWunmulac1d
50 Makasar SultanmiddotAlaudfn No 259 Bahasa Indonesia bull R~ular 1 Yeai Muhammadlyah MakaSSal (Indonesian - Regular 6 Month UnIVersity Telp (041 1881593 41nguage) (UNISMUH Fax (0411) 865588 Makasal) Web WWWunlsmuhaeid
51 UnlVerty of Jalan Perintis Kemerdekaao Bahasa Indonesia - Regular 1 Year Hasanuddln KM 10 Makasser (Indonesian - Regular 6 Month Makasar (UNHAS) Teip (0411) 584002 588200 Language)
Fax (0411) 58518B Web wwwunhasscid
52 Sam Ratulangi ~Bahaaa Indonesia ~ Regular 1 Year University Manado
KamPUB UntalBshu (IndonesianMenado North Sulawesi bull Regular 6 Month
(UNSRAT) Telp (0431) 863785 863886 language) bull Summer 3 Monthmiddot Fall (0431) a22568 middotPerlkanan amp web wwwunsrataQid Kelautan (Flsherfes
and Marine) - PerUinlan jAgricuHureJ
bull Regular 1Year Komputer
Jt Oipatl Ukur 102 118 bullTeknr~ Komputer53 Universitas (Computer
Indonasla Bandung4Q132
Technology) (UNIKOIiI) Bandung
Tep (022) 250 3J)54 bull Sistemlnfonnasi
Webwwwunlkornscid Fax (022) 253 3754
(Information System) bull Akunlansl
I(Accounting)
Bureau of Planning and Il)femationalCooperation Ministry of Educatlonand Culture
I l
i
8
9 University of Udayana (UNUD) Bali
Komplek Kampus Jlmbaran Denpas8r Telp (0361) 701954 Fax (0361)701907 Website httpwwwunudacld
Southeast Asia EconomY
bull Hospitality amI resort design
bull Southeasl Asian Vernacular
Bureau of Planning and Intematlonal Cooperation Mini$try of EducatiDn and Culture
10
---------------------
-------------------
t bull
laquo bull
MtNISTRY qF EDUCATI~ ANP CULTURE THE GOVERNMENT OF THE REPUBLlC OF INDONESIA
JalaB JeDdera Sudinn~D - SenaYln J A K ART A lO70
TelpJFu (62 - 01) 5724707 573J181) 5711144 Ext 1610 Website darmasiswakqmdikaasgoid E-mail darmasiswaJdilyahoocom
APPUCATION FORM SCHOLARS8IP FORDARMASISWA RI PROGRAMmiddot
INSTRUCTIONS
Please answer each questions clearly and completely Type or print in ink Read carefully and follow all directions Ifyou more spac~ attaoh additional pages of the same size Submit the completed fonn duly signed in lhroo copies to the Indonesian EmbassyIDipJomaticRef)resentative in your country
A PERSONAL DETAILS
I a Family name
b First name
2 Date of birth affix photo here
J Plllce ofhirth 4x6cm
4 MalclFemale
5 Nationality
6 Religion
7 Paspor Number Validity of
8 E-maH
9 a Mariml status 0 Single a Married b Do you have a husbandiwife or any dependan~
(Please give details ofnaine relationship and date of birth)
NO NAME RELATIONSHIP AGE
I
------ --- ------ ----- ------- - -- ~--
bull
D PROPOSED PROGRAM AND FlELD OF STIJDV (to be answered as detailed as possible)
I Program aD Regular I Year
bD Summer 6 Month
c 0 Regular) Month
Frst Chpice
Place ofStudy
Subject ofStudy
SecondCholu
Place ofStudy
Subject ofStudy
2 Outline your proposed field ofSludy and indicate the pracdcal use to be made of this study Ifyou are acquainted with the possibilities ofstudy offered in Indonesia iisntle institutes or projects you propose to study or the specific course you wish to attend
(Additional pa~lerfor mnre information)
)
--------~-~--~
List any siggificant publication you have written (do not attach)
l-ave you applied for any other scholarship DYes o No
SU~~lb________________________________________________~_
Organiz8rion
Period from ___________ to-------------__
Travel (List period spent away from YOllr home country)
Country visited
(~ OTHERS Experience abroad
No C0untry
~
Reason for ~isit or residel)cc abroad
Purpose
-
Dat~s
Year
-shy
w
shy
5
b 6 (six) months regular program would start on the beginning of August
2012 until January 2013
c 1 (one) year regular program would start on the beginning of August
2012 until July 2013
10Specificaltyfor participantswho would like to study in Universitas Indonesia
(UI the study schedule would start by the End ofJuly 2012
IV VISA
The visa for participating in this program is a 60 days Visa Kunjungan Sosial
Budaya (VKS8) which could be attained through the nearest Indonesian Embassy
or Consulate in the country where the participants live Further the visa would
be converted according to the study period to receive a stay permit after the
participants arrive in Indonesia through the National Secretariat of the Republic
of Indonesia and the General Directorate of Immigration the Department of Law
and Human Rights
The participants are not allowed to use Tourist Visa or OnmiddotArrival Visa to study
in Indonfisia since this could cause problem when applying for a stay permit in
Indonesta
V sOtOLARSHIP GRANTED
The amount of scholarship received by the participants is Rp 2000000 (two
million Rupiah) per month with details as follow
a living Cost Rp 1200000shy
b Text Books Cost Rp 200000shy
c Local Transport Rp 200000shy
d Health Cost Rp 200000shy
e Allowance Rp 200000
Since the amount is not enough for everydays needs the participants are
strongly encouraged to take along additional money in USD in order to ease the
exchange with Rupiah
2 Direkur Diplomasl Publlk
Direktorat JenderaUnformasl dan Diplomas Publik
Kementerian Luar Negeri
Jalan Taman PeJambon No6
Jakarta -Indonesia
Telepon (021) 3813480 Faks (021)3858035
VIII THE TRAVELUNG OF PARTICIPANTS TO INDONESIA
The government of the Republic of Indonesia in this The Bureau of Foreign
Cooperation and Planning Department of Education and Culture (Depdikbud)
does not providetravelling fees from and to the participants respective G~untiY
Oepdikbud would cover-a one way ticket froni Jakarta-to the province where the
higher education institution is located while the returning ticket would be the
obliged to the participants
IX HEALTH INSURANCE
Oepdikbud does not provide insurance Perticipants are expected to have
international insurance prior to departureto Indonesia
The Bureau of Foreign Cooperation and Planning Department of Education and
Culture
XI LIST OF UNiVERSmES AND COLLEGES ORGANIZING IN THE REGULAR 1 (ONE) YEAR AND REGULAR 8 (SIX)MONTH ~ROGRAM
NO HfGHSR
EDUCATION INSmUnON
ADDRESS MAJOR PROGRAM
1 Medan State middotUnlversily (UNIMED
Witlem Iskandar Psr V Medan Estate Medan Telp(Q61 )6~13365 Fax (061) 6613319 Web wwwunimedac1d
Bahasa Indonesia (Indonesian Language)
- ~e9ular 1 Year - Regular eMonth
2 Anifalas Unhiersfty (UNAND) PADANG
Rektoral UnandKampus Manis Padang Telp (07~1) 71303 Fax (0751) 71985 Web WNWunandac1d
Bahasalndonesfa ( Indonesian Language)
- Regular 1 Year - Regular 6 Month
_3 Indqnesian Art Institute qf Padang Panjang (lSi Padang Panjang)
Bund~ Kanduang 35 Padang Panjang Sumatera Baral Telp (0752) 820n Fax (0752) 82803 Web wwwlsl-
IDadangpaniangae1d
- Karawitan (Tredit~nal MUsic) - Sen Tali (Dance) -Senl Kriya (Handicraft)
- Regular 1 Year
4 Srtiijaya -University UNSRI Palembang
RayaPrabumulih Indralaya OKI Palembang Telp 0711) 580357 Web wwwunsriacid
BahasaJndonesla (indonesian Language)
- Regurar 1 Yeaf - Regular 6 Month
5 Univen1ty of Bina Danna Palembllng
JI Jenderal Ahmad Vanl No 24 Palembang30264 Telpbull (0711)7080181 Fax (0711)513018 Web WVNIblnadannaacidmiddot
Bahasa Indonesia Indonesian Language)
- Regular 1 Yeal - Regular 6 Month
5 Lampung Unlerslty (UNltA)
Profl Dr SumantJ BrojonegoroNo 1 Bandsr Lampung 35145 Telp (0121) 701609 Fax (0721) 702787 WebwwwuniIBac1d
Bahasalndonesia [Indonesian Language)
- Regular 1 Year bull Regular 6 Month
6 University of fndonesia (UI) Jakarta
Kampus UI Depok 16424 Jawa Barat Teip (021) 7270009 7S63f2B 7863529 7B64075 FalC O21 7270038 Web WWYIuiacid
BahBsalndonesfa (InC1oneslan Language)
-
bull Regular 1 Year - Regular 6 Month
1 Jakarta State University (UJt
RawaMsngun MUkai JKT 13220 1felpfFax (021) 4893982 Web VtWWunJacid
Banasalndqnesia (ll1doneslan Langu~)
bull Regular 1 Year - Regular 6 Month
8 Nasfonal University (UNASbullbull Jakarta
Sawo Manila rajat Pasar Mlnggu Jaka$ 12520 Telp (021)7808700 Fex (021) 7802718119 Web wwwunasacld
Bahasa Indonesia Jndoneslan Language)
- Regular 1 Year bull Regular e Monttl
2
18 State University of Semarang (UNNESJ
Kampus UNNES Gedung H Sekaren Gunungpatl T~lp (024) 8508004 Web wwwunnesac1d
bull Sahasalndonesla (Indonesian Language) bull Senl ~upa (Fin Art) - Sem Kriya (HSlldlcraft) - Serll Muslk (Music Tradtlonal bull Senl Tan (TradltJon~1 Dance) bull Senl Batik (Batik Art)
- RegUlar 1 Year bull Regular SMonth
19 Teacher and Educational Institutemiddotof PGRI Semarang (lKIP PGRI Semarang)
Kampus I rLontatNo 1 (Sldodadl Tlmur) Semarang KarnpLlS II Llngga Raya No 1Semaraog Telp (024) 8448Z17 83163n Fax (024) 8448217 Web wwwtIdppgrtsmrgnet
Bahasa Indonesia (lndimeslan language)
- Regular Year - ReguJar 6 Month
20 SoogtJapranata Catflollc UniverSity ofSemarang (UNIKA SoegijBpranata Semarang
JL Pawiyatan Luhur IVli Bendan Ouwur Semarang middot50234 Telp (024) 8441555 Fax (024f84452656 8415429 Website wwwuniksacid
bull Indonesian Traditional Herbal Medicine
bull Eillerpreneurship and Social Responsbilily
- Regular 1 Year - Regular 6 MOnth
21 UniVersity of Jenderal Soedirman Purwokerto
JI Prof Or HR Boenjamln 708 PO BGX 15 Purwoker1o Telp (0281) 63529294 Fax (0281) 631602
Bahasa Indonesia (IJ1dOn~ian language)
bull Regular 1 Year ~ Regular EI Month
22 lndonesian Art Institute of Yogyakarta (lSI Yogyakarta
Parangtrltis Km 6~ 01 YOgyakar1a ielpJFax (O274311233 Webslfe httpwwwislacd
- SenlKriya (Handicraft) - SeniTari Tredslonal (Traditiona Dance) - Karawitan (Traditional Music) -Fotografi Photography)
- Regular 1 Year
23 University of Gad)ahMada (UGM) Yogyakarta
Bulaksumu-r 01 Yogyakarra Telp(0274) 563974 Website httpwNvvugmacld
Bahasa Indonesia (Indonesian language)
bull Regular 1Year -Regular B Month
24 Stale University of Yogyakarta (UNY)
Karangmalang 01 Yogyakaria -Telp (0274) 586168 ext 316 Fax (0274) 565500 Website httpwwwunyacJd
Ir
Bahasa rdonesla (Indonesian Language)
- Regular 1 Year bull Regular 6 Month
4
32 State University of Surabaya NO 6 Bahasa rndonesia - Regular 1 Year Malang Malang - Jawa Tlmur (Indonesian ~ Regular 6Month (UMrMalang Tefp1 Fax (0341) 551312 L8nguege)
Websitewwwmalang8cld
33 Teachrand Sirnpang Arjuno 14 B Regular 1 Year Educational
- BahasaJn~esia Maang (lndQnesfan - RegtJlar 6 Month
Institute of Budi Teip (0341) 326019 Language) UtOmoMlln9 (IKIP 323214 -Senl Budl Utomo Fax (0341) 326019 (Art) Malang) Websitlil
wwwJk~budlutomoacld
34 Polytechnic of Jalan Veleran PO BOX 04 Bahasa Indonetia - Regular 1 Year Malang Malang 65145 (Indonesfan - Regular 6 Month (POLINEMA) TelpiFax (0341) 562158 Language)
Website (tIWN poltek-malangacid
35 Malang Ja~n Raya Ttogomas24B Bahasa Inacnesia - Regular 1 Year Muhammadiyah Maiang (IndOnesian - Regular 6 Month University (UMM Telp (0341)46431819 Language)
Faits (0341) 460782 I 460345 Website WWWummacid
36 VoCational Jalan Teluk MaIIdar AljOsari Bahasa Indonesia - Regular 1 Year Education Tromol Pos 5 Malang 65102 (I ndonesian Development TeJp (0341) 491239 Language) Center (P4lK) Website Teknol9il1 Malena httpwwwvedc ma~rtgcom
37 University of Jalan Kalimantan 37 Bahasa Indonesia - Regular 1 Year Jamber Kampus TegarSoto (Indotl8slan - Regular 6 Month (OJ) Language)
T~lp (0331) 337422 F~(0331337422
~ember68121
Email relctorunejecJd Web wwwuneJac1d Kampus IKlP Surabaya Bahasa Indonesia38 Slale University of -Regular 1 Year
Surabaya (Indonesian bull Regular 6 Month (UNESA)
~tintang Language)
Telp (031) 8290357 Surabaya - Jaws Timur
Website httDilwwwunesascld
39 Ainangga Kanpus C Mulyorejo bull Regular 1 Yaar University
- Bahasafndonesla Surabaya e011 6 bull Farmaey (Herb) - Regular eMonltl
(UNAIR) Surabaya Telp (031) 5914042 5912546 Fax (031) 5961841 Website httpilwwwunalracld
40 - Regular 1 Year University of
SUtorejo No 59 Surabaya Bahasa IndonesiaMuham~dlYllh Telp (031) 3811966 (Indonesian - Regular 6 Month
Surabaya (UNMUH language) Surabaya)
Fax (031) 3813096 WebSite httpwINwacid
I
6
~ 49 Mulawarman Kamp1 Unmul ~Jnung Bahasa Indonesia - Regular 1Year
UnIversity Kelu8 Kotak Pas 1068 (Indonesian bull Regular 6 Month CUNMUL) Samarinda languag~) Kalimantan Timur Telp(0541) 748698
Fax (0541) 747479 WebWWWunmulac1d
50 Makasar SultanmiddotAlaudfn No 259 Bahasa Indonesia bull R~ular 1 Yeai Muhammadlyah MakaSSal (Indonesian - Regular 6 Month UnIVersity Telp (041 1881593 41nguage) (UNISMUH Fax (0411) 865588 Makasal) Web WWWunlsmuhaeid
51 UnlVerty of Jalan Perintis Kemerdekaao Bahasa Indonesia - Regular 1 Year Hasanuddln KM 10 Makasser (Indonesian - Regular 6 Month Makasar (UNHAS) Teip (0411) 584002 588200 Language)
Fax (0411) 58518B Web wwwunhasscid
52 Sam Ratulangi ~Bahaaa Indonesia ~ Regular 1 Year University Manado
KamPUB UntalBshu (IndonesianMenado North Sulawesi bull Regular 6 Month
(UNSRAT) Telp (0431) 863785 863886 language) bull Summer 3 Monthmiddot Fall (0431) a22568 middotPerlkanan amp web wwwunsrataQid Kelautan (Flsherfes
and Marine) - PerUinlan jAgricuHureJ
bull Regular 1Year Komputer
Jt Oipatl Ukur 102 118 bullTeknr~ Komputer53 Universitas (Computer
Indonasla Bandung4Q132
Technology) (UNIKOIiI) Bandung
Tep (022) 250 3J)54 bull Sistemlnfonnasi
Webwwwunlkornscid Fax (022) 253 3754
(Information System) bull Akunlansl
I(Accounting)
Bureau of Planning and Il)femationalCooperation Ministry of Educatlonand Culture
I l
i
8
9 University of Udayana (UNUD) Bali
Komplek Kampus Jlmbaran Denpas8r Telp (0361) 701954 Fax (0361)701907 Website httpwwwunudacld
Southeast Asia EconomY
bull Hospitality amI resort design
bull Southeasl Asian Vernacular
Bureau of Planning and Intematlonal Cooperation Mini$try of EducatiDn and Culture
10
---------------------
-------------------
t bull
laquo bull
MtNISTRY qF EDUCATI~ ANP CULTURE THE GOVERNMENT OF THE REPUBLlC OF INDONESIA
JalaB JeDdera Sudinn~D - SenaYln J A K ART A lO70
TelpJFu (62 - 01) 5724707 573J181) 5711144 Ext 1610 Website darmasiswakqmdikaasgoid E-mail darmasiswaJdilyahoocom
APPUCATION FORM SCHOLARS8IP FORDARMASISWA RI PROGRAMmiddot
INSTRUCTIONS
Please answer each questions clearly and completely Type or print in ink Read carefully and follow all directions Ifyou more spac~ attaoh additional pages of the same size Submit the completed fonn duly signed in lhroo copies to the Indonesian EmbassyIDipJomaticRef)resentative in your country
A PERSONAL DETAILS
I a Family name
b First name
2 Date of birth affix photo here
J Plllce ofhirth 4x6cm
4 MalclFemale
5 Nationality
6 Religion
7 Paspor Number Validity of
8 E-maH
9 a Mariml status 0 Single a Married b Do you have a husbandiwife or any dependan~
(Please give details ofnaine relationship and date of birth)
NO NAME RELATIONSHIP AGE
I
------ --- ------ ----- ------- - -- ~--
bull
D PROPOSED PROGRAM AND FlELD OF STIJDV (to be answered as detailed as possible)
I Program aD Regular I Year
bD Summer 6 Month
c 0 Regular) Month
Frst Chpice
Place ofStudy
Subject ofStudy
SecondCholu
Place ofStudy
Subject ofStudy
2 Outline your proposed field ofSludy and indicate the pracdcal use to be made of this study Ifyou are acquainted with the possibilities ofstudy offered in Indonesia iisntle institutes or projects you propose to study or the specific course you wish to attend
(Additional pa~lerfor mnre information)
)
--------~-~--~
List any siggificant publication you have written (do not attach)
l-ave you applied for any other scholarship DYes o No
SU~~lb________________________________________________~_
Organiz8rion
Period from ___________ to-------------__
Travel (List period spent away from YOllr home country)
Country visited
(~ OTHERS Experience abroad
No C0untry
~
Reason for ~isit or residel)cc abroad
Purpose
-
Dat~s
Year
-shy
w
shy
5
2 Direkur Diplomasl Publlk
Direktorat JenderaUnformasl dan Diplomas Publik
Kementerian Luar Negeri
Jalan Taman PeJambon No6
Jakarta -Indonesia
Telepon (021) 3813480 Faks (021)3858035
VIII THE TRAVELUNG OF PARTICIPANTS TO INDONESIA
The government of the Republic of Indonesia in this The Bureau of Foreign
Cooperation and Planning Department of Education and Culture (Depdikbud)
does not providetravelling fees from and to the participants respective G~untiY
Oepdikbud would cover-a one way ticket froni Jakarta-to the province where the
higher education institution is located while the returning ticket would be the
obliged to the participants
IX HEALTH INSURANCE
Oepdikbud does not provide insurance Perticipants are expected to have
international insurance prior to departureto Indonesia
The Bureau of Foreign Cooperation and Planning Department of Education and
Culture
XI LIST OF UNiVERSmES AND COLLEGES ORGANIZING IN THE REGULAR 1 (ONE) YEAR AND REGULAR 8 (SIX)MONTH ~ROGRAM
NO HfGHSR
EDUCATION INSmUnON
ADDRESS MAJOR PROGRAM
1 Medan State middotUnlversily (UNIMED
Witlem Iskandar Psr V Medan Estate Medan Telp(Q61 )6~13365 Fax (061) 6613319 Web wwwunimedac1d
Bahasa Indonesia (Indonesian Language)
- ~e9ular 1 Year - Regular eMonth
2 Anifalas Unhiersfty (UNAND) PADANG
Rektoral UnandKampus Manis Padang Telp (07~1) 71303 Fax (0751) 71985 Web WNWunandac1d
Bahasalndonesfa ( Indonesian Language)
- Regular 1 Year - Regular 6 Month
_3 Indqnesian Art Institute qf Padang Panjang (lSi Padang Panjang)
Bund~ Kanduang 35 Padang Panjang Sumatera Baral Telp (0752) 820n Fax (0752) 82803 Web wwwlsl-
IDadangpaniangae1d
- Karawitan (Tredit~nal MUsic) - Sen Tali (Dance) -Senl Kriya (Handicraft)
- Regular 1 Year
4 Srtiijaya -University UNSRI Palembang
RayaPrabumulih Indralaya OKI Palembang Telp 0711) 580357 Web wwwunsriacid
BahasaJndonesla (indonesian Language)
- Regurar 1 Yeaf - Regular 6 Month
5 Univen1ty of Bina Danna Palembllng
JI Jenderal Ahmad Vanl No 24 Palembang30264 Telpbull (0711)7080181 Fax (0711)513018 Web WVNIblnadannaacidmiddot
Bahasa Indonesia Indonesian Language)
- Regular 1 Yeal - Regular 6 Month
5 Lampung Unlerslty (UNltA)
Profl Dr SumantJ BrojonegoroNo 1 Bandsr Lampung 35145 Telp (0121) 701609 Fax (0721) 702787 WebwwwuniIBac1d
Bahasalndonesia [Indonesian Language)
- Regular 1 Year bull Regular 6 Month
6 University of fndonesia (UI) Jakarta
Kampus UI Depok 16424 Jawa Barat Teip (021) 7270009 7S63f2B 7863529 7B64075 FalC O21 7270038 Web WWYIuiacid
BahBsalndonesfa (InC1oneslan Language)
-
bull Regular 1 Year - Regular 6 Month
1 Jakarta State University (UJt
RawaMsngun MUkai JKT 13220 1felpfFax (021) 4893982 Web VtWWunJacid
Banasalndqnesia (ll1doneslan Langu~)
bull Regular 1 Year - Regular 6 Month
8 Nasfonal University (UNASbullbull Jakarta
Sawo Manila rajat Pasar Mlnggu Jaka$ 12520 Telp (021)7808700 Fex (021) 7802718119 Web wwwunasacld
Bahasa Indonesia Jndoneslan Language)
- Regular 1 Year bull Regular e Monttl
2
18 State University of Semarang (UNNESJ
Kampus UNNES Gedung H Sekaren Gunungpatl T~lp (024) 8508004 Web wwwunnesac1d
bull Sahasalndonesla (Indonesian Language) bull Senl ~upa (Fin Art) - Sem Kriya (HSlldlcraft) - Serll Muslk (Music Tradtlonal bull Senl Tan (TradltJon~1 Dance) bull Senl Batik (Batik Art)
- RegUlar 1 Year bull Regular SMonth
19 Teacher and Educational Institutemiddotof PGRI Semarang (lKIP PGRI Semarang)
Kampus I rLontatNo 1 (Sldodadl Tlmur) Semarang KarnpLlS II Llngga Raya No 1Semaraog Telp (024) 8448Z17 83163n Fax (024) 8448217 Web wwwtIdppgrtsmrgnet
Bahasa Indonesia (lndimeslan language)
- Regular Year - ReguJar 6 Month
20 SoogtJapranata Catflollc UniverSity ofSemarang (UNIKA SoegijBpranata Semarang
JL Pawiyatan Luhur IVli Bendan Ouwur Semarang middot50234 Telp (024) 8441555 Fax (024f84452656 8415429 Website wwwuniksacid
bull Indonesian Traditional Herbal Medicine
bull Eillerpreneurship and Social Responsbilily
- Regular 1 Year - Regular 6 MOnth
21 UniVersity of Jenderal Soedirman Purwokerto
JI Prof Or HR Boenjamln 708 PO BGX 15 Purwoker1o Telp (0281) 63529294 Fax (0281) 631602
Bahasa Indonesia (IJ1dOn~ian language)
bull Regular 1 Year ~ Regular EI Month
22 lndonesian Art Institute of Yogyakarta (lSI Yogyakarta
Parangtrltis Km 6~ 01 YOgyakar1a ielpJFax (O274311233 Webslfe httpwwwislacd
- SenlKriya (Handicraft) - SeniTari Tredslonal (Traditiona Dance) - Karawitan (Traditional Music) -Fotografi Photography)
- Regular 1 Year
23 University of Gad)ahMada (UGM) Yogyakarta
Bulaksumu-r 01 Yogyakarra Telp(0274) 563974 Website httpwNvvugmacld
Bahasa Indonesia (Indonesian language)
bull Regular 1Year -Regular B Month
24 Stale University of Yogyakarta (UNY)
Karangmalang 01 Yogyakaria -Telp (0274) 586168 ext 316 Fax (0274) 565500 Website httpwwwunyacJd
Ir
Bahasa rdonesla (Indonesian Language)
- Regular 1 Year bull Regular 6 Month
4
32 State University of Surabaya NO 6 Bahasa rndonesia - Regular 1 Year Malang Malang - Jawa Tlmur (Indonesian ~ Regular 6Month (UMrMalang Tefp1 Fax (0341) 551312 L8nguege)
Websitewwwmalang8cld
33 Teachrand Sirnpang Arjuno 14 B Regular 1 Year Educational
- BahasaJn~esia Maang (lndQnesfan - RegtJlar 6 Month
Institute of Budi Teip (0341) 326019 Language) UtOmoMlln9 (IKIP 323214 -Senl Budl Utomo Fax (0341) 326019 (Art) Malang) Websitlil
wwwJk~budlutomoacld
34 Polytechnic of Jalan Veleran PO BOX 04 Bahasa Indonetia - Regular 1 Year Malang Malang 65145 (Indonesfan - Regular 6 Month (POLINEMA) TelpiFax (0341) 562158 Language)
Website (tIWN poltek-malangacid
35 Malang Ja~n Raya Ttogomas24B Bahasa Inacnesia - Regular 1 Year Muhammadiyah Maiang (IndOnesian - Regular 6 Month University (UMM Telp (0341)46431819 Language)
Faits (0341) 460782 I 460345 Website WWWummacid
36 VoCational Jalan Teluk MaIIdar AljOsari Bahasa Indonesia - Regular 1 Year Education Tromol Pos 5 Malang 65102 (I ndonesian Development TeJp (0341) 491239 Language) Center (P4lK) Website Teknol9il1 Malena httpwwwvedc ma~rtgcom
37 University of Jalan Kalimantan 37 Bahasa Indonesia - Regular 1 Year Jamber Kampus TegarSoto (Indotl8slan - Regular 6 Month (OJ) Language)
T~lp (0331) 337422 F~(0331337422
~ember68121
Email relctorunejecJd Web wwwuneJac1d Kampus IKlP Surabaya Bahasa Indonesia38 Slale University of -Regular 1 Year
Surabaya (Indonesian bull Regular 6 Month (UNESA)
~tintang Language)
Telp (031) 8290357 Surabaya - Jaws Timur
Website httDilwwwunesascld
39 Ainangga Kanpus C Mulyorejo bull Regular 1 Yaar University
- Bahasafndonesla Surabaya e011 6 bull Farmaey (Herb) - Regular eMonltl
(UNAIR) Surabaya Telp (031) 5914042 5912546 Fax (031) 5961841 Website httpilwwwunalracld
40 - Regular 1 Year University of
SUtorejo No 59 Surabaya Bahasa IndonesiaMuham~dlYllh Telp (031) 3811966 (Indonesian - Regular 6 Month
Surabaya (UNMUH language) Surabaya)
Fax (031) 3813096 WebSite httpwINwacid
I
6
~ 49 Mulawarman Kamp1 Unmul ~Jnung Bahasa Indonesia - Regular 1Year
UnIversity Kelu8 Kotak Pas 1068 (Indonesian bull Regular 6 Month CUNMUL) Samarinda languag~) Kalimantan Timur Telp(0541) 748698
Fax (0541) 747479 WebWWWunmulac1d
50 Makasar SultanmiddotAlaudfn No 259 Bahasa Indonesia bull R~ular 1 Yeai Muhammadlyah MakaSSal (Indonesian - Regular 6 Month UnIVersity Telp (041 1881593 41nguage) (UNISMUH Fax (0411) 865588 Makasal) Web WWWunlsmuhaeid
51 UnlVerty of Jalan Perintis Kemerdekaao Bahasa Indonesia - Regular 1 Year Hasanuddln KM 10 Makasser (Indonesian - Regular 6 Month Makasar (UNHAS) Teip (0411) 584002 588200 Language)
Fax (0411) 58518B Web wwwunhasscid
52 Sam Ratulangi ~Bahaaa Indonesia ~ Regular 1 Year University Manado
KamPUB UntalBshu (IndonesianMenado North Sulawesi bull Regular 6 Month
(UNSRAT) Telp (0431) 863785 863886 language) bull Summer 3 Monthmiddot Fall (0431) a22568 middotPerlkanan amp web wwwunsrataQid Kelautan (Flsherfes
and Marine) - PerUinlan jAgricuHureJ
bull Regular 1Year Komputer
Jt Oipatl Ukur 102 118 bullTeknr~ Komputer53 Universitas (Computer
Indonasla Bandung4Q132
Technology) (UNIKOIiI) Bandung
Tep (022) 250 3J)54 bull Sistemlnfonnasi
Webwwwunlkornscid Fax (022) 253 3754
(Information System) bull Akunlansl
I(Accounting)
Bureau of Planning and Il)femationalCooperation Ministry of Educatlonand Culture
I l
i
8
9 University of Udayana (UNUD) Bali
Komplek Kampus Jlmbaran Denpas8r Telp (0361) 701954 Fax (0361)701907 Website httpwwwunudacld
Southeast Asia EconomY
bull Hospitality amI resort design
bull Southeasl Asian Vernacular
Bureau of Planning and Intematlonal Cooperation Mini$try of EducatiDn and Culture
10
---------------------
-------------------
t bull
laquo bull
MtNISTRY qF EDUCATI~ ANP CULTURE THE GOVERNMENT OF THE REPUBLlC OF INDONESIA
JalaB JeDdera Sudinn~D - SenaYln J A K ART A lO70
TelpJFu (62 - 01) 5724707 573J181) 5711144 Ext 1610 Website darmasiswakqmdikaasgoid E-mail darmasiswaJdilyahoocom
APPUCATION FORM SCHOLARS8IP FORDARMASISWA RI PROGRAMmiddot
INSTRUCTIONS
Please answer each questions clearly and completely Type or print in ink Read carefully and follow all directions Ifyou more spac~ attaoh additional pages of the same size Submit the completed fonn duly signed in lhroo copies to the Indonesian EmbassyIDipJomaticRef)resentative in your country
A PERSONAL DETAILS
I a Family name
b First name
2 Date of birth affix photo here
J Plllce ofhirth 4x6cm
4 MalclFemale
5 Nationality
6 Religion
7 Paspor Number Validity of
8 E-maH
9 a Mariml status 0 Single a Married b Do you have a husbandiwife or any dependan~
(Please give details ofnaine relationship and date of birth)
NO NAME RELATIONSHIP AGE
I
------ --- ------ ----- ------- - -- ~--
bull
D PROPOSED PROGRAM AND FlELD OF STIJDV (to be answered as detailed as possible)
I Program aD Regular I Year
bD Summer 6 Month
c 0 Regular) Month
Frst Chpice
Place ofStudy
Subject ofStudy
SecondCholu
Place ofStudy
Subject ofStudy
2 Outline your proposed field ofSludy and indicate the pracdcal use to be made of this study Ifyou are acquainted with the possibilities ofstudy offered in Indonesia iisntle institutes or projects you propose to study or the specific course you wish to attend
(Additional pa~lerfor mnre information)
)
--------~-~--~
List any siggificant publication you have written (do not attach)
l-ave you applied for any other scholarship DYes o No
SU~~lb________________________________________________~_
Organiz8rion
Period from ___________ to-------------__
Travel (List period spent away from YOllr home country)
Country visited
(~ OTHERS Experience abroad
No C0untry
~
Reason for ~isit or residel)cc abroad
Purpose
-
Dat~s
Year
-shy
w
shy
5
XI LIST OF UNiVERSmES AND COLLEGES ORGANIZING IN THE REGULAR 1 (ONE) YEAR AND REGULAR 8 (SIX)MONTH ~ROGRAM
NO HfGHSR
EDUCATION INSmUnON
ADDRESS MAJOR PROGRAM
1 Medan State middotUnlversily (UNIMED
Witlem Iskandar Psr V Medan Estate Medan Telp(Q61 )6~13365 Fax (061) 6613319 Web wwwunimedac1d
Bahasa Indonesia (Indonesian Language)
- ~e9ular 1 Year - Regular eMonth
2 Anifalas Unhiersfty (UNAND) PADANG
Rektoral UnandKampus Manis Padang Telp (07~1) 71303 Fax (0751) 71985 Web WNWunandac1d
Bahasalndonesfa ( Indonesian Language)
- Regular 1 Year - Regular 6 Month
_3 Indqnesian Art Institute qf Padang Panjang (lSi Padang Panjang)
Bund~ Kanduang 35 Padang Panjang Sumatera Baral Telp (0752) 820n Fax (0752) 82803 Web wwwlsl-
IDadangpaniangae1d
- Karawitan (Tredit~nal MUsic) - Sen Tali (Dance) -Senl Kriya (Handicraft)
- Regular 1 Year
4 Srtiijaya -University UNSRI Palembang
RayaPrabumulih Indralaya OKI Palembang Telp 0711) 580357 Web wwwunsriacid
BahasaJndonesla (indonesian Language)
- Regurar 1 Yeaf - Regular 6 Month
5 Univen1ty of Bina Danna Palembllng
JI Jenderal Ahmad Vanl No 24 Palembang30264 Telpbull (0711)7080181 Fax (0711)513018 Web WVNIblnadannaacidmiddot
Bahasa Indonesia Indonesian Language)
- Regular 1 Yeal - Regular 6 Month
5 Lampung Unlerslty (UNltA)
Profl Dr SumantJ BrojonegoroNo 1 Bandsr Lampung 35145 Telp (0121) 701609 Fax (0721) 702787 WebwwwuniIBac1d
Bahasalndonesia [Indonesian Language)
- Regular 1 Year bull Regular 6 Month
6 University of fndonesia (UI) Jakarta
Kampus UI Depok 16424 Jawa Barat Teip (021) 7270009 7S63f2B 7863529 7B64075 FalC O21 7270038 Web WWYIuiacid
BahBsalndonesfa (InC1oneslan Language)
-
bull Regular 1 Year - Regular 6 Month
1 Jakarta State University (UJt
RawaMsngun MUkai JKT 13220 1felpfFax (021) 4893982 Web VtWWunJacid
Banasalndqnesia (ll1doneslan Langu~)
bull Regular 1 Year - Regular 6 Month
8 Nasfonal University (UNASbullbull Jakarta
Sawo Manila rajat Pasar Mlnggu Jaka$ 12520 Telp (021)7808700 Fex (021) 7802718119 Web wwwunasacld
Bahasa Indonesia Jndoneslan Language)
- Regular 1 Year bull Regular e Monttl
2
18 State University of Semarang (UNNESJ
Kampus UNNES Gedung H Sekaren Gunungpatl T~lp (024) 8508004 Web wwwunnesac1d
bull Sahasalndonesla (Indonesian Language) bull Senl ~upa (Fin Art) - Sem Kriya (HSlldlcraft) - Serll Muslk (Music Tradtlonal bull Senl Tan (TradltJon~1 Dance) bull Senl Batik (Batik Art)
- RegUlar 1 Year bull Regular SMonth
19 Teacher and Educational Institutemiddotof PGRI Semarang (lKIP PGRI Semarang)
Kampus I rLontatNo 1 (Sldodadl Tlmur) Semarang KarnpLlS II Llngga Raya No 1Semaraog Telp (024) 8448Z17 83163n Fax (024) 8448217 Web wwwtIdppgrtsmrgnet
Bahasa Indonesia (lndimeslan language)
- Regular Year - ReguJar 6 Month
20 SoogtJapranata Catflollc UniverSity ofSemarang (UNIKA SoegijBpranata Semarang
JL Pawiyatan Luhur IVli Bendan Ouwur Semarang middot50234 Telp (024) 8441555 Fax (024f84452656 8415429 Website wwwuniksacid
bull Indonesian Traditional Herbal Medicine
bull Eillerpreneurship and Social Responsbilily
- Regular 1 Year - Regular 6 MOnth
21 UniVersity of Jenderal Soedirman Purwokerto
JI Prof Or HR Boenjamln 708 PO BGX 15 Purwoker1o Telp (0281) 63529294 Fax (0281) 631602
Bahasa Indonesia (IJ1dOn~ian language)
bull Regular 1 Year ~ Regular EI Month
22 lndonesian Art Institute of Yogyakarta (lSI Yogyakarta
Parangtrltis Km 6~ 01 YOgyakar1a ielpJFax (O274311233 Webslfe httpwwwislacd
- SenlKriya (Handicraft) - SeniTari Tredslonal (Traditiona Dance) - Karawitan (Traditional Music) -Fotografi Photography)
- Regular 1 Year
23 University of Gad)ahMada (UGM) Yogyakarta
Bulaksumu-r 01 Yogyakarra Telp(0274) 563974 Website httpwNvvugmacld
Bahasa Indonesia (Indonesian language)
bull Regular 1Year -Regular B Month
24 Stale University of Yogyakarta (UNY)
Karangmalang 01 Yogyakaria -Telp (0274) 586168 ext 316 Fax (0274) 565500 Website httpwwwunyacJd
Ir
Bahasa rdonesla (Indonesian Language)
- Regular 1 Year bull Regular 6 Month
4
32 State University of Surabaya NO 6 Bahasa rndonesia - Regular 1 Year Malang Malang - Jawa Tlmur (Indonesian ~ Regular 6Month (UMrMalang Tefp1 Fax (0341) 551312 L8nguege)
Websitewwwmalang8cld
33 Teachrand Sirnpang Arjuno 14 B Regular 1 Year Educational
- BahasaJn~esia Maang (lndQnesfan - RegtJlar 6 Month
Institute of Budi Teip (0341) 326019 Language) UtOmoMlln9 (IKIP 323214 -Senl Budl Utomo Fax (0341) 326019 (Art) Malang) Websitlil
wwwJk~budlutomoacld
34 Polytechnic of Jalan Veleran PO BOX 04 Bahasa Indonetia - Regular 1 Year Malang Malang 65145 (Indonesfan - Regular 6 Month (POLINEMA) TelpiFax (0341) 562158 Language)
Website (tIWN poltek-malangacid
35 Malang Ja~n Raya Ttogomas24B Bahasa Inacnesia - Regular 1 Year Muhammadiyah Maiang (IndOnesian - Regular 6 Month University (UMM Telp (0341)46431819 Language)
Faits (0341) 460782 I 460345 Website WWWummacid
36 VoCational Jalan Teluk MaIIdar AljOsari Bahasa Indonesia - Regular 1 Year Education Tromol Pos 5 Malang 65102 (I ndonesian Development TeJp (0341) 491239 Language) Center (P4lK) Website Teknol9il1 Malena httpwwwvedc ma~rtgcom
37 University of Jalan Kalimantan 37 Bahasa Indonesia - Regular 1 Year Jamber Kampus TegarSoto (Indotl8slan - Regular 6 Month (OJ) Language)
T~lp (0331) 337422 F~(0331337422
~ember68121
Email relctorunejecJd Web wwwuneJac1d Kampus IKlP Surabaya Bahasa Indonesia38 Slale University of -Regular 1 Year
Surabaya (Indonesian bull Regular 6 Month (UNESA)
~tintang Language)
Telp (031) 8290357 Surabaya - Jaws Timur
Website httDilwwwunesascld
39 Ainangga Kanpus C Mulyorejo bull Regular 1 Yaar University
- Bahasafndonesla Surabaya e011 6 bull Farmaey (Herb) - Regular eMonltl
(UNAIR) Surabaya Telp (031) 5914042 5912546 Fax (031) 5961841 Website httpilwwwunalracld
40 - Regular 1 Year University of
SUtorejo No 59 Surabaya Bahasa IndonesiaMuham~dlYllh Telp (031) 3811966 (Indonesian - Regular 6 Month
Surabaya (UNMUH language) Surabaya)
Fax (031) 3813096 WebSite httpwINwacid
I
6
~ 49 Mulawarman Kamp1 Unmul ~Jnung Bahasa Indonesia - Regular 1Year
UnIversity Kelu8 Kotak Pas 1068 (Indonesian bull Regular 6 Month CUNMUL) Samarinda languag~) Kalimantan Timur Telp(0541) 748698
Fax (0541) 747479 WebWWWunmulac1d
50 Makasar SultanmiddotAlaudfn No 259 Bahasa Indonesia bull R~ular 1 Yeai Muhammadlyah MakaSSal (Indonesian - Regular 6 Month UnIVersity Telp (041 1881593 41nguage) (UNISMUH Fax (0411) 865588 Makasal) Web WWWunlsmuhaeid
51 UnlVerty of Jalan Perintis Kemerdekaao Bahasa Indonesia - Regular 1 Year Hasanuddln KM 10 Makasser (Indonesian - Regular 6 Month Makasar (UNHAS) Teip (0411) 584002 588200 Language)
Fax (0411) 58518B Web wwwunhasscid
52 Sam Ratulangi ~Bahaaa Indonesia ~ Regular 1 Year University Manado
KamPUB UntalBshu (IndonesianMenado North Sulawesi bull Regular 6 Month
(UNSRAT) Telp (0431) 863785 863886 language) bull Summer 3 Monthmiddot Fall (0431) a22568 middotPerlkanan amp web wwwunsrataQid Kelautan (Flsherfes
and Marine) - PerUinlan jAgricuHureJ
bull Regular 1Year Komputer
Jt Oipatl Ukur 102 118 bullTeknr~ Komputer53 Universitas (Computer
Indonasla Bandung4Q132
Technology) (UNIKOIiI) Bandung
Tep (022) 250 3J)54 bull Sistemlnfonnasi
Webwwwunlkornscid Fax (022) 253 3754
(Information System) bull Akunlansl
I(Accounting)
Bureau of Planning and Il)femationalCooperation Ministry of Educatlonand Culture
I l
i
8
9 University of Udayana (UNUD) Bali
Komplek Kampus Jlmbaran Denpas8r Telp (0361) 701954 Fax (0361)701907 Website httpwwwunudacld
Southeast Asia EconomY
bull Hospitality amI resort design
bull Southeasl Asian Vernacular
Bureau of Planning and Intematlonal Cooperation Mini$try of EducatiDn and Culture
10
---------------------
-------------------
t bull
laquo bull
MtNISTRY qF EDUCATI~ ANP CULTURE THE GOVERNMENT OF THE REPUBLlC OF INDONESIA
JalaB JeDdera Sudinn~D - SenaYln J A K ART A lO70
TelpJFu (62 - 01) 5724707 573J181) 5711144 Ext 1610 Website darmasiswakqmdikaasgoid E-mail darmasiswaJdilyahoocom
APPUCATION FORM SCHOLARS8IP FORDARMASISWA RI PROGRAMmiddot
INSTRUCTIONS
Please answer each questions clearly and completely Type or print in ink Read carefully and follow all directions Ifyou more spac~ attaoh additional pages of the same size Submit the completed fonn duly signed in lhroo copies to the Indonesian EmbassyIDipJomaticRef)resentative in your country
A PERSONAL DETAILS
I a Family name
b First name
2 Date of birth affix photo here
J Plllce ofhirth 4x6cm
4 MalclFemale
5 Nationality
6 Religion
7 Paspor Number Validity of
8 E-maH
9 a Mariml status 0 Single a Married b Do you have a husbandiwife or any dependan~
(Please give details ofnaine relationship and date of birth)
NO NAME RELATIONSHIP AGE
I
------ --- ------ ----- ------- - -- ~--
bull
D PROPOSED PROGRAM AND FlELD OF STIJDV (to be answered as detailed as possible)
I Program aD Regular I Year
bD Summer 6 Month
c 0 Regular) Month
Frst Chpice
Place ofStudy
Subject ofStudy
SecondCholu
Place ofStudy
Subject ofStudy
2 Outline your proposed field ofSludy and indicate the pracdcal use to be made of this study Ifyou are acquainted with the possibilities ofstudy offered in Indonesia iisntle institutes or projects you propose to study or the specific course you wish to attend
(Additional pa~lerfor mnre information)
)
--------~-~--~
List any siggificant publication you have written (do not attach)
l-ave you applied for any other scholarship DYes o No
SU~~lb________________________________________________~_
Organiz8rion
Period from ___________ to-------------__
Travel (List period spent away from YOllr home country)
Country visited
(~ OTHERS Experience abroad
No C0untry
~
Reason for ~isit or residel)cc abroad
Purpose
-
Dat~s
Year
-shy
w
shy
5
18 State University of Semarang (UNNESJ
Kampus UNNES Gedung H Sekaren Gunungpatl T~lp (024) 8508004 Web wwwunnesac1d
bull Sahasalndonesla (Indonesian Language) bull Senl ~upa (Fin Art) - Sem Kriya (HSlldlcraft) - Serll Muslk (Music Tradtlonal bull Senl Tan (TradltJon~1 Dance) bull Senl Batik (Batik Art)
- RegUlar 1 Year bull Regular SMonth
19 Teacher and Educational Institutemiddotof PGRI Semarang (lKIP PGRI Semarang)
Kampus I rLontatNo 1 (Sldodadl Tlmur) Semarang KarnpLlS II Llngga Raya No 1Semaraog Telp (024) 8448Z17 83163n Fax (024) 8448217 Web wwwtIdppgrtsmrgnet
Bahasa Indonesia (lndimeslan language)
- Regular Year - ReguJar 6 Month
20 SoogtJapranata Catflollc UniverSity ofSemarang (UNIKA SoegijBpranata Semarang
JL Pawiyatan Luhur IVli Bendan Ouwur Semarang middot50234 Telp (024) 8441555 Fax (024f84452656 8415429 Website wwwuniksacid
bull Indonesian Traditional Herbal Medicine
bull Eillerpreneurship and Social Responsbilily
- Regular 1 Year - Regular 6 MOnth
21 UniVersity of Jenderal Soedirman Purwokerto
JI Prof Or HR Boenjamln 708 PO BGX 15 Purwoker1o Telp (0281) 63529294 Fax (0281) 631602
Bahasa Indonesia (IJ1dOn~ian language)
bull Regular 1 Year ~ Regular EI Month
22 lndonesian Art Institute of Yogyakarta (lSI Yogyakarta
Parangtrltis Km 6~ 01 YOgyakar1a ielpJFax (O274311233 Webslfe httpwwwislacd
- SenlKriya (Handicraft) - SeniTari Tredslonal (Traditiona Dance) - Karawitan (Traditional Music) -Fotografi Photography)
- Regular 1 Year
23 University of Gad)ahMada (UGM) Yogyakarta
Bulaksumu-r 01 Yogyakarra Telp(0274) 563974 Website httpwNvvugmacld
Bahasa Indonesia (Indonesian language)
bull Regular 1Year -Regular B Month
24 Stale University of Yogyakarta (UNY)
Karangmalang 01 Yogyakaria -Telp (0274) 586168 ext 316 Fax (0274) 565500 Website httpwwwunyacJd
Ir
Bahasa rdonesla (Indonesian Language)
- Regular 1 Year bull Regular 6 Month
4
32 State University of Surabaya NO 6 Bahasa rndonesia - Regular 1 Year Malang Malang - Jawa Tlmur (Indonesian ~ Regular 6Month (UMrMalang Tefp1 Fax (0341) 551312 L8nguege)
Websitewwwmalang8cld
33 Teachrand Sirnpang Arjuno 14 B Regular 1 Year Educational
- BahasaJn~esia Maang (lndQnesfan - RegtJlar 6 Month
Institute of Budi Teip (0341) 326019 Language) UtOmoMlln9 (IKIP 323214 -Senl Budl Utomo Fax (0341) 326019 (Art) Malang) Websitlil
wwwJk~budlutomoacld
34 Polytechnic of Jalan Veleran PO BOX 04 Bahasa Indonetia - Regular 1 Year Malang Malang 65145 (Indonesfan - Regular 6 Month (POLINEMA) TelpiFax (0341) 562158 Language)
Website (tIWN poltek-malangacid
35 Malang Ja~n Raya Ttogomas24B Bahasa Inacnesia - Regular 1 Year Muhammadiyah Maiang (IndOnesian - Regular 6 Month University (UMM Telp (0341)46431819 Language)
Faits (0341) 460782 I 460345 Website WWWummacid
36 VoCational Jalan Teluk MaIIdar AljOsari Bahasa Indonesia - Regular 1 Year Education Tromol Pos 5 Malang 65102 (I ndonesian Development TeJp (0341) 491239 Language) Center (P4lK) Website Teknol9il1 Malena httpwwwvedc ma~rtgcom
37 University of Jalan Kalimantan 37 Bahasa Indonesia - Regular 1 Year Jamber Kampus TegarSoto (Indotl8slan - Regular 6 Month (OJ) Language)
T~lp (0331) 337422 F~(0331337422
~ember68121
Email relctorunejecJd Web wwwuneJac1d Kampus IKlP Surabaya Bahasa Indonesia38 Slale University of -Regular 1 Year
Surabaya (Indonesian bull Regular 6 Month (UNESA)
~tintang Language)
Telp (031) 8290357 Surabaya - Jaws Timur
Website httDilwwwunesascld
39 Ainangga Kanpus C Mulyorejo bull Regular 1 Yaar University
- Bahasafndonesla Surabaya e011 6 bull Farmaey (Herb) - Regular eMonltl
(UNAIR) Surabaya Telp (031) 5914042 5912546 Fax (031) 5961841 Website httpilwwwunalracld
40 - Regular 1 Year University of
SUtorejo No 59 Surabaya Bahasa IndonesiaMuham~dlYllh Telp (031) 3811966 (Indonesian - Regular 6 Month
Surabaya (UNMUH language) Surabaya)
Fax (031) 3813096 WebSite httpwINwacid
I
6
~ 49 Mulawarman Kamp1 Unmul ~Jnung Bahasa Indonesia - Regular 1Year
UnIversity Kelu8 Kotak Pas 1068 (Indonesian bull Regular 6 Month CUNMUL) Samarinda languag~) Kalimantan Timur Telp(0541) 748698
Fax (0541) 747479 WebWWWunmulac1d
50 Makasar SultanmiddotAlaudfn No 259 Bahasa Indonesia bull R~ular 1 Yeai Muhammadlyah MakaSSal (Indonesian - Regular 6 Month UnIVersity Telp (041 1881593 41nguage) (UNISMUH Fax (0411) 865588 Makasal) Web WWWunlsmuhaeid
51 UnlVerty of Jalan Perintis Kemerdekaao Bahasa Indonesia - Regular 1 Year Hasanuddln KM 10 Makasser (Indonesian - Regular 6 Month Makasar (UNHAS) Teip (0411) 584002 588200 Language)
Fax (0411) 58518B Web wwwunhasscid
52 Sam Ratulangi ~Bahaaa Indonesia ~ Regular 1 Year University Manado
KamPUB UntalBshu (IndonesianMenado North Sulawesi bull Regular 6 Month
(UNSRAT) Telp (0431) 863785 863886 language) bull Summer 3 Monthmiddot Fall (0431) a22568 middotPerlkanan amp web wwwunsrataQid Kelautan (Flsherfes
and Marine) - PerUinlan jAgricuHureJ
bull Regular 1Year Komputer
Jt Oipatl Ukur 102 118 bullTeknr~ Komputer53 Universitas (Computer
Indonasla Bandung4Q132
Technology) (UNIKOIiI) Bandung
Tep (022) 250 3J)54 bull Sistemlnfonnasi
Webwwwunlkornscid Fax (022) 253 3754
(Information System) bull Akunlansl
I(Accounting)
Bureau of Planning and Il)femationalCooperation Ministry of Educatlonand Culture
I l
i
8
9 University of Udayana (UNUD) Bali
Komplek Kampus Jlmbaran Denpas8r Telp (0361) 701954 Fax (0361)701907 Website httpwwwunudacld
Southeast Asia EconomY
bull Hospitality amI resort design
bull Southeasl Asian Vernacular
Bureau of Planning and Intematlonal Cooperation Mini$try of EducatiDn and Culture
10
---------------------
-------------------
t bull
laquo bull
MtNISTRY qF EDUCATI~ ANP CULTURE THE GOVERNMENT OF THE REPUBLlC OF INDONESIA
JalaB JeDdera Sudinn~D - SenaYln J A K ART A lO70
TelpJFu (62 - 01) 5724707 573J181) 5711144 Ext 1610 Website darmasiswakqmdikaasgoid E-mail darmasiswaJdilyahoocom
APPUCATION FORM SCHOLARS8IP FORDARMASISWA RI PROGRAMmiddot
INSTRUCTIONS
Please answer each questions clearly and completely Type or print in ink Read carefully and follow all directions Ifyou more spac~ attaoh additional pages of the same size Submit the completed fonn duly signed in lhroo copies to the Indonesian EmbassyIDipJomaticRef)resentative in your country
A PERSONAL DETAILS
I a Family name
b First name
2 Date of birth affix photo here
J Plllce ofhirth 4x6cm
4 MalclFemale
5 Nationality
6 Religion
7 Paspor Number Validity of
8 E-maH
9 a Mariml status 0 Single a Married b Do you have a husbandiwife or any dependan~
(Please give details ofnaine relationship and date of birth)
NO NAME RELATIONSHIP AGE
I
------ --- ------ ----- ------- - -- ~--
bull
D PROPOSED PROGRAM AND FlELD OF STIJDV (to be answered as detailed as possible)
I Program aD Regular I Year
bD Summer 6 Month
c 0 Regular) Month
Frst Chpice
Place ofStudy
Subject ofStudy
SecondCholu
Place ofStudy
Subject ofStudy
2 Outline your proposed field ofSludy and indicate the pracdcal use to be made of this study Ifyou are acquainted with the possibilities ofstudy offered in Indonesia iisntle institutes or projects you propose to study or the specific course you wish to attend
(Additional pa~lerfor mnre information)
)
--------~-~--~
List any siggificant publication you have written (do not attach)
l-ave you applied for any other scholarship DYes o No
SU~~lb________________________________________________~_
Organiz8rion
Period from ___________ to-------------__
Travel (List period spent away from YOllr home country)
Country visited
(~ OTHERS Experience abroad
No C0untry
~
Reason for ~isit or residel)cc abroad
Purpose
-
Dat~s
Year
-shy
w
shy
5
32 State University of Surabaya NO 6 Bahasa rndonesia - Regular 1 Year Malang Malang - Jawa Tlmur (Indonesian ~ Regular 6Month (UMrMalang Tefp1 Fax (0341) 551312 L8nguege)
Websitewwwmalang8cld
33 Teachrand Sirnpang Arjuno 14 B Regular 1 Year Educational
- BahasaJn~esia Maang (lndQnesfan - RegtJlar 6 Month
Institute of Budi Teip (0341) 326019 Language) UtOmoMlln9 (IKIP 323214 -Senl Budl Utomo Fax (0341) 326019 (Art) Malang) Websitlil
wwwJk~budlutomoacld
34 Polytechnic of Jalan Veleran PO BOX 04 Bahasa Indonetia - Regular 1 Year Malang Malang 65145 (Indonesfan - Regular 6 Month (POLINEMA) TelpiFax (0341) 562158 Language)
Website (tIWN poltek-malangacid
35 Malang Ja~n Raya Ttogomas24B Bahasa Inacnesia - Regular 1 Year Muhammadiyah Maiang (IndOnesian - Regular 6 Month University (UMM Telp (0341)46431819 Language)
Faits (0341) 460782 I 460345 Website WWWummacid
36 VoCational Jalan Teluk MaIIdar AljOsari Bahasa Indonesia - Regular 1 Year Education Tromol Pos 5 Malang 65102 (I ndonesian Development TeJp (0341) 491239 Language) Center (P4lK) Website Teknol9il1 Malena httpwwwvedc ma~rtgcom
37 University of Jalan Kalimantan 37 Bahasa Indonesia - Regular 1 Year Jamber Kampus TegarSoto (Indotl8slan - Regular 6 Month (OJ) Language)
T~lp (0331) 337422 F~(0331337422
~ember68121
Email relctorunejecJd Web wwwuneJac1d Kampus IKlP Surabaya Bahasa Indonesia38 Slale University of -Regular 1 Year
Surabaya (Indonesian bull Regular 6 Month (UNESA)
~tintang Language)
Telp (031) 8290357 Surabaya - Jaws Timur
Website httDilwwwunesascld
39 Ainangga Kanpus C Mulyorejo bull Regular 1 Yaar University
- Bahasafndonesla Surabaya e011 6 bull Farmaey (Herb) - Regular eMonltl
(UNAIR) Surabaya Telp (031) 5914042 5912546 Fax (031) 5961841 Website httpilwwwunalracld
40 - Regular 1 Year University of
SUtorejo No 59 Surabaya Bahasa IndonesiaMuham~dlYllh Telp (031) 3811966 (Indonesian - Regular 6 Month
Surabaya (UNMUH language) Surabaya)
Fax (031) 3813096 WebSite httpwINwacid
I
6
~ 49 Mulawarman Kamp1 Unmul ~Jnung Bahasa Indonesia - Regular 1Year
UnIversity Kelu8 Kotak Pas 1068 (Indonesian bull Regular 6 Month CUNMUL) Samarinda languag~) Kalimantan Timur Telp(0541) 748698
Fax (0541) 747479 WebWWWunmulac1d
50 Makasar SultanmiddotAlaudfn No 259 Bahasa Indonesia bull R~ular 1 Yeai Muhammadlyah MakaSSal (Indonesian - Regular 6 Month UnIVersity Telp (041 1881593 41nguage) (UNISMUH Fax (0411) 865588 Makasal) Web WWWunlsmuhaeid
51 UnlVerty of Jalan Perintis Kemerdekaao Bahasa Indonesia - Regular 1 Year Hasanuddln KM 10 Makasser (Indonesian - Regular 6 Month Makasar (UNHAS) Teip (0411) 584002 588200 Language)
Fax (0411) 58518B Web wwwunhasscid
52 Sam Ratulangi ~Bahaaa Indonesia ~ Regular 1 Year University Manado
KamPUB UntalBshu (IndonesianMenado North Sulawesi bull Regular 6 Month
(UNSRAT) Telp (0431) 863785 863886 language) bull Summer 3 Monthmiddot Fall (0431) a22568 middotPerlkanan amp web wwwunsrataQid Kelautan (Flsherfes
and Marine) - PerUinlan jAgricuHureJ
bull Regular 1Year Komputer
Jt Oipatl Ukur 102 118 bullTeknr~ Komputer53 Universitas (Computer
Indonasla Bandung4Q132
Technology) (UNIKOIiI) Bandung
Tep (022) 250 3J)54 bull Sistemlnfonnasi
Webwwwunlkornscid Fax (022) 253 3754
(Information System) bull Akunlansl
I(Accounting)
Bureau of Planning and Il)femationalCooperation Ministry of Educatlonand Culture
I l
i
8
9 University of Udayana (UNUD) Bali
Komplek Kampus Jlmbaran Denpas8r Telp (0361) 701954 Fax (0361)701907 Website httpwwwunudacld
Southeast Asia EconomY
bull Hospitality amI resort design
bull Southeasl Asian Vernacular
Bureau of Planning and Intematlonal Cooperation Mini$try of EducatiDn and Culture
10
---------------------
-------------------
t bull
laquo bull
MtNISTRY qF EDUCATI~ ANP CULTURE THE GOVERNMENT OF THE REPUBLlC OF INDONESIA
JalaB JeDdera Sudinn~D - SenaYln J A K ART A lO70
TelpJFu (62 - 01) 5724707 573J181) 5711144 Ext 1610 Website darmasiswakqmdikaasgoid E-mail darmasiswaJdilyahoocom
APPUCATION FORM SCHOLARS8IP FORDARMASISWA RI PROGRAMmiddot
INSTRUCTIONS
Please answer each questions clearly and completely Type or print in ink Read carefully and follow all directions Ifyou more spac~ attaoh additional pages of the same size Submit the completed fonn duly signed in lhroo copies to the Indonesian EmbassyIDipJomaticRef)resentative in your country
A PERSONAL DETAILS
I a Family name
b First name
2 Date of birth affix photo here
J Plllce ofhirth 4x6cm
4 MalclFemale
5 Nationality
6 Religion
7 Paspor Number Validity of
8 E-maH
9 a Mariml status 0 Single a Married b Do you have a husbandiwife or any dependan~
(Please give details ofnaine relationship and date of birth)
NO NAME RELATIONSHIP AGE
I
------ --- ------ ----- ------- - -- ~--
bull
D PROPOSED PROGRAM AND FlELD OF STIJDV (to be answered as detailed as possible)
I Program aD Regular I Year
bD Summer 6 Month
c 0 Regular) Month
Frst Chpice
Place ofStudy
Subject ofStudy
SecondCholu
Place ofStudy
Subject ofStudy
2 Outline your proposed field ofSludy and indicate the pracdcal use to be made of this study Ifyou are acquainted with the possibilities ofstudy offered in Indonesia iisntle institutes or projects you propose to study or the specific course you wish to attend
(Additional pa~lerfor mnre information)
)
--------~-~--~
List any siggificant publication you have written (do not attach)
l-ave you applied for any other scholarship DYes o No
SU~~lb________________________________________________~_
Organiz8rion
Period from ___________ to-------------__
Travel (List period spent away from YOllr home country)
Country visited
(~ OTHERS Experience abroad
No C0untry
~
Reason for ~isit or residel)cc abroad
Purpose
-
Dat~s
Year
-shy
w
shy
5
~ 49 Mulawarman Kamp1 Unmul ~Jnung Bahasa Indonesia - Regular 1Year
UnIversity Kelu8 Kotak Pas 1068 (Indonesian bull Regular 6 Month CUNMUL) Samarinda languag~) Kalimantan Timur Telp(0541) 748698
Fax (0541) 747479 WebWWWunmulac1d
50 Makasar SultanmiddotAlaudfn No 259 Bahasa Indonesia bull R~ular 1 Yeai Muhammadlyah MakaSSal (Indonesian - Regular 6 Month UnIVersity Telp (041 1881593 41nguage) (UNISMUH Fax (0411) 865588 Makasal) Web WWWunlsmuhaeid
51 UnlVerty of Jalan Perintis Kemerdekaao Bahasa Indonesia - Regular 1 Year Hasanuddln KM 10 Makasser (Indonesian - Regular 6 Month Makasar (UNHAS) Teip (0411) 584002 588200 Language)
Fax (0411) 58518B Web wwwunhasscid
52 Sam Ratulangi ~Bahaaa Indonesia ~ Regular 1 Year University Manado
KamPUB UntalBshu (IndonesianMenado North Sulawesi bull Regular 6 Month
(UNSRAT) Telp (0431) 863785 863886 language) bull Summer 3 Monthmiddot Fall (0431) a22568 middotPerlkanan amp web wwwunsrataQid Kelautan (Flsherfes
and Marine) - PerUinlan jAgricuHureJ
bull Regular 1Year Komputer
Jt Oipatl Ukur 102 118 bullTeknr~ Komputer53 Universitas (Computer
Indonasla Bandung4Q132
Technology) (UNIKOIiI) Bandung
Tep (022) 250 3J)54 bull Sistemlnfonnasi
Webwwwunlkornscid Fax (022) 253 3754
(Information System) bull Akunlansl
I(Accounting)
Bureau of Planning and Il)femationalCooperation Ministry of Educatlonand Culture
I l
i
8
9 University of Udayana (UNUD) Bali
Komplek Kampus Jlmbaran Denpas8r Telp (0361) 701954 Fax (0361)701907 Website httpwwwunudacld
Southeast Asia EconomY
bull Hospitality amI resort design
bull Southeasl Asian Vernacular
Bureau of Planning and Intematlonal Cooperation Mini$try of EducatiDn and Culture
10
---------------------
-------------------
t bull
laquo bull
MtNISTRY qF EDUCATI~ ANP CULTURE THE GOVERNMENT OF THE REPUBLlC OF INDONESIA
JalaB JeDdera Sudinn~D - SenaYln J A K ART A lO70
TelpJFu (62 - 01) 5724707 573J181) 5711144 Ext 1610 Website darmasiswakqmdikaasgoid E-mail darmasiswaJdilyahoocom
APPUCATION FORM SCHOLARS8IP FORDARMASISWA RI PROGRAMmiddot
INSTRUCTIONS
Please answer each questions clearly and completely Type or print in ink Read carefully and follow all directions Ifyou more spac~ attaoh additional pages of the same size Submit the completed fonn duly signed in lhroo copies to the Indonesian EmbassyIDipJomaticRef)resentative in your country
A PERSONAL DETAILS
I a Family name
b First name
2 Date of birth affix photo here
J Plllce ofhirth 4x6cm
4 MalclFemale
5 Nationality
6 Religion
7 Paspor Number Validity of
8 E-maH
9 a Mariml status 0 Single a Married b Do you have a husbandiwife or any dependan~
(Please give details ofnaine relationship and date of birth)
NO NAME RELATIONSHIP AGE
I
------ --- ------ ----- ------- - -- ~--
bull
D PROPOSED PROGRAM AND FlELD OF STIJDV (to be answered as detailed as possible)
I Program aD Regular I Year
bD Summer 6 Month
c 0 Regular) Month
Frst Chpice
Place ofStudy
Subject ofStudy
SecondCholu
Place ofStudy
Subject ofStudy
2 Outline your proposed field ofSludy and indicate the pracdcal use to be made of this study Ifyou are acquainted with the possibilities ofstudy offered in Indonesia iisntle institutes or projects you propose to study or the specific course you wish to attend
(Additional pa~lerfor mnre information)
)
--------~-~--~
List any siggificant publication you have written (do not attach)
l-ave you applied for any other scholarship DYes o No
SU~~lb________________________________________________~_
Organiz8rion
Period from ___________ to-------------__
Travel (List period spent away from YOllr home country)
Country visited
(~ OTHERS Experience abroad
No C0untry
~
Reason for ~isit or residel)cc abroad
Purpose
-
Dat~s
Year
-shy
w
shy
5
9 University of Udayana (UNUD) Bali
Komplek Kampus Jlmbaran Denpas8r Telp (0361) 701954 Fax (0361)701907 Website httpwwwunudacld
Southeast Asia EconomY
bull Hospitality amI resort design
bull Southeasl Asian Vernacular
Bureau of Planning and Intematlonal Cooperation Mini$try of EducatiDn and Culture
10
---------------------
-------------------
t bull
laquo bull
MtNISTRY qF EDUCATI~ ANP CULTURE THE GOVERNMENT OF THE REPUBLlC OF INDONESIA
JalaB JeDdera Sudinn~D - SenaYln J A K ART A lO70
TelpJFu (62 - 01) 5724707 573J181) 5711144 Ext 1610 Website darmasiswakqmdikaasgoid E-mail darmasiswaJdilyahoocom
APPUCATION FORM SCHOLARS8IP FORDARMASISWA RI PROGRAMmiddot
INSTRUCTIONS
Please answer each questions clearly and completely Type or print in ink Read carefully and follow all directions Ifyou more spac~ attaoh additional pages of the same size Submit the completed fonn duly signed in lhroo copies to the Indonesian EmbassyIDipJomaticRef)resentative in your country
A PERSONAL DETAILS
I a Family name
b First name
2 Date of birth affix photo here
J Plllce ofhirth 4x6cm
4 MalclFemale
5 Nationality
6 Religion
7 Paspor Number Validity of
8 E-maH
9 a Mariml status 0 Single a Married b Do you have a husbandiwife or any dependan~
(Please give details ofnaine relationship and date of birth)
NO NAME RELATIONSHIP AGE
I
------ --- ------ ----- ------- - -- ~--
bull
D PROPOSED PROGRAM AND FlELD OF STIJDV (to be answered as detailed as possible)
I Program aD Regular I Year
bD Summer 6 Month
c 0 Regular) Month
Frst Chpice
Place ofStudy
Subject ofStudy
SecondCholu
Place ofStudy
Subject ofStudy
2 Outline your proposed field ofSludy and indicate the pracdcal use to be made of this study Ifyou are acquainted with the possibilities ofstudy offered in Indonesia iisntle institutes or projects you propose to study or the specific course you wish to attend
(Additional pa~lerfor mnre information)
)
--------~-~--~
List any siggificant publication you have written (do not attach)
l-ave you applied for any other scholarship DYes o No
SU~~lb________________________________________________~_
Organiz8rion
Period from ___________ to-------------__
Travel (List period spent away from YOllr home country)
Country visited
(~ OTHERS Experience abroad
No C0untry
~
Reason for ~isit or residel)cc abroad
Purpose
-
Dat~s
Year
-shy
w
shy
5
---------------------
-------------------
t bull
laquo bull
MtNISTRY qF EDUCATI~ ANP CULTURE THE GOVERNMENT OF THE REPUBLlC OF INDONESIA
JalaB JeDdera Sudinn~D - SenaYln J A K ART A lO70
TelpJFu (62 - 01) 5724707 573J181) 5711144 Ext 1610 Website darmasiswakqmdikaasgoid E-mail darmasiswaJdilyahoocom
APPUCATION FORM SCHOLARS8IP FORDARMASISWA RI PROGRAMmiddot
INSTRUCTIONS
Please answer each questions clearly and completely Type or print in ink Read carefully and follow all directions Ifyou more spac~ attaoh additional pages of the same size Submit the completed fonn duly signed in lhroo copies to the Indonesian EmbassyIDipJomaticRef)resentative in your country
A PERSONAL DETAILS
I a Family name
b First name
2 Date of birth affix photo here
J Plllce ofhirth 4x6cm
4 MalclFemale
5 Nationality
6 Religion
7 Paspor Number Validity of
8 E-maH
9 a Mariml status 0 Single a Married b Do you have a husbandiwife or any dependan~
(Please give details ofnaine relationship and date of birth)
NO NAME RELATIONSHIP AGE
I
------ --- ------ ----- ------- - -- ~--
bull
D PROPOSED PROGRAM AND FlELD OF STIJDV (to be answered as detailed as possible)
I Program aD Regular I Year
bD Summer 6 Month
c 0 Regular) Month
Frst Chpice
Place ofStudy
Subject ofStudy
SecondCholu
Place ofStudy
Subject ofStudy
2 Outline your proposed field ofSludy and indicate the pracdcal use to be made of this study Ifyou are acquainted with the possibilities ofstudy offered in Indonesia iisntle institutes or projects you propose to study or the specific course you wish to attend
(Additional pa~lerfor mnre information)
)
--------~-~--~
List any siggificant publication you have written (do not attach)
l-ave you applied for any other scholarship DYes o No
SU~~lb________________________________________________~_
Organiz8rion
Period from ___________ to-------------__
Travel (List period spent away from YOllr home country)
Country visited
(~ OTHERS Experience abroad
No C0untry
~
Reason for ~isit or residel)cc abroad
Purpose
-
Dat~s
Year
-shy
w
shy
5
bull
D PROPOSED PROGRAM AND FlELD OF STIJDV (to be answered as detailed as possible)
I Program aD Regular I Year
bD Summer 6 Month
c 0 Regular) Month
Frst Chpice
Place ofStudy
Subject ofStudy
SecondCholu
Place ofStudy
Subject ofStudy
2 Outline your proposed field ofSludy and indicate the pracdcal use to be made of this study Ifyou are acquainted with the possibilities ofstudy offered in Indonesia iisntle institutes or projects you propose to study or the specific course you wish to attend
(Additional pa~lerfor mnre information)
)
--------~-~--~
List any siggificant publication you have written (do not attach)
l-ave you applied for any other scholarship DYes o No
SU~~lb________________________________________________~_
Organiz8rion
Period from ___________ to-------------__
Travel (List period spent away from YOllr home country)
Country visited
(~ OTHERS Experience abroad
No C0untry
~
Reason for ~isit or residel)cc abroad
Purpose
-
Dat~s
Year
-shy
w
shy
5
--------~-~--~
List any siggificant publication you have written (do not attach)
l-ave you applied for any other scholarship DYes o No
SU~~lb________________________________________________~_
Organiz8rion
Period from ___________ to-------------__
Travel (List period spent away from YOllr home country)
Country visited
(~ OTHERS Experience abroad
No C0untry
~
Reason for ~isit or residel)cc abroad
Purpose
-
Dat~s
Year
-shy
w
shy
5
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