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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

------ --- ------ ----- ------- - -- ~--

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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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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

Page 3: r,~~[t - db.grad.nu.ac.thpornthip/pdf/Scholarship/2012_01_12_ZelandA… · Oepdikbud would cover-a one way ticket froni Jakarta-to the province where the higher education institution

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

Page 4: r,~~[t - db.grad.nu.ac.thpornthip/pdf/Scholarship/2012_01_12_ZelandA… · Oepdikbud would cover-a one way ticket froni Jakarta-to the province where the 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

Page 5: r,~~[t - db.grad.nu.ac.thpornthip/pdf/Scholarship/2012_01_12_ZelandA… · Oepdikbud would cover-a one way ticket froni Jakarta-to the province where the higher education institution

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

Page 6: r,~~[t - db.grad.nu.ac.thpornthip/pdf/Scholarship/2012_01_12_ZelandA… · Oepdikbud would cover-a one way ticket froni Jakarta-to the province where the higher education institution

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

Page 7: r,~~[t - db.grad.nu.ac.thpornthip/pdf/Scholarship/2012_01_12_ZelandA… · Oepdikbud would cover-a one way ticket froni Jakarta-to the province where the higher education institution

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

Page 8: r,~~[t - db.grad.nu.ac.thpornthip/pdf/Scholarship/2012_01_12_ZelandA… · Oepdikbud would cover-a one way ticket froni Jakarta-to the province where the higher education institution

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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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

Page 9: r,~~[t - db.grad.nu.ac.thpornthip/pdf/Scholarship/2012_01_12_ZelandA… · Oepdikbud would cover-a one way ticket froni Jakarta-to the province where the higher education institution

~ 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

Page 10: r,~~[t - db.grad.nu.ac.thpornthip/pdf/Scholarship/2012_01_12_ZelandA… · Oepdikbud would cover-a one way ticket froni Jakarta-to the province where the higher education institution

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

Page 11: r,~~[t - db.grad.nu.ac.thpornthip/pdf/Scholarship/2012_01_12_ZelandA… · Oepdikbud would cover-a one way ticket froni Jakarta-to the province where the higher education institution

---------------------

-------------------

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

Page 12: r,~~[t - db.grad.nu.ac.thpornthip/pdf/Scholarship/2012_01_12_ZelandA… · Oepdikbud would cover-a one way ticket froni Jakarta-to the province where the higher education institution

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

Page 13: r,~~[t - db.grad.nu.ac.thpornthip/pdf/Scholarship/2012_01_12_ZelandA… · Oepdikbud would cover-a one way ticket froni Jakarta-to the province where the higher education institution

--------~-~--~

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