USAID STARENERGY Scholarship Application 2013

7/29/2019 USAID STARENERGY Scholarship Application 2013

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Scholarship Application Geothermal EngineeringITB

Application Formfor USAID-STAR

ENERGY SCHOLAR AWARDFunded by:

&

Star Energy Geothermal (WayangWindu) Ltd

In Agreement with:

In collaboration with:

InstitutTeknologi Bandung (ITB)

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USAID- STAR ENERGY SCHOLARS AWARDS

USAID-STAR ENERGY Scholars awards provide a range of opportunities for

Indonesian citizens to develop their capacities, knowledge, and skills by performinga study and research at Magister Program of Geothermal Technology, InstitutTeknologi Bandung.

GOAL

The objective of this program is to increase the capacity of available professionalmanpower in the geothermal sector in Indonesia. This includes manpower in theindustries, government, and academic.

SCHOLARSHIP ENTITLEMENTS

The scholarships will be given to 10 Master degree students each year. It coverstuition and fees, books, and field trips required for every students during their study(maximum of 4 semesters program).

SCHOLARSHIP REQUIREMENTS

Prior to applying the scholarship, there is a number of requirements to bemet:

Scholarship applicants must:

have a minimum 3.25/4.00 cumulative GPA from previous study

(undergraduate program).

meet the minimum English language requirement from Institutional TOEFL of

550 or equivalent IELTS of 6.5

meet the Academic Potential Test/TesPotensiAkademik(similar to GRE)

minimum score of 500

provide letter of statement that they will enroll as full time students at ITB

Master Program

provide formal letter of permission from employer to leave the work and

study full time at ITB Master Program (for applicants that are currentlyemployed)

pass test and interview

be less than 40 years of age by the time of admission (certificate of birth date

is required)

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For students whom the scholarship are granted, their performance will be evaluatedevery semester by academic committee.

SCHOLARSHIP CONDITIONS

Scholarship Awardees must:

commence the study in academic calendar by the time the scholarship isoffered

complete the full study program in maximum 4 semesters during their

scholarship program

agree for a scholarship termination or cancelation at any time due to specific

reason as follows: failure to make satisfactory academic progress or failure tocomplete scholarship award within the period as stipulated under contractbetween students and academic committee

be in charge of being present in all lectures and tutorial, including fulfill the

assignments (task and essay) and sit for the examinations

actively participate in all activities related to the academic program held by

Geothermal Technology Magister Program, including seminars, course, fieldtrip or field camp

be permitted from the employer to leave their work temporarily to be a full

time student (for applicants that are currently employed)

DOCUMENTS REQUIRED

To help you ensure that you have fulfilled all the documents required, it isimportant to have all the lists below checked with thick mark () beforeyou submit your application.All applicants must provide TWO copies ofapplication form (one original copy and one photocopy), completed in English.Each copy of the application form must include:

A signed application declaration

A certified copy of birth certificate

A copy of Identification Card (Passport or KTP KartuTandaPenduduk)

The most recent Curriculum Vitae (including brief history of study, work,

competencies or skill)

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A certified graduation certificate

A certified academic transcript

TOEFL or IELTS test results

TPA Test PotensiAkademik, similar to GRE

A current job description (confirming your position and outlining your

responsibilities and duties) If you are currently employed

Two references on official letterhead from former lecturers or employer

Medical document of color blindness for applicants enrolled for explorationspecialization

A 500 word statement describing the specific skills and knowledge you want to gain from your

proposed study and how this will contribute to your current and/or future job.

A 1000 word statement describing how your proposed area of study will enable you to contribute

to the social or economic development of your organization.

A1000 word statement outlining your proposed research topic.

A copy of your doctors assessment

All statements have to be written in English

FURTHER INFORMATION

Further information on the USAID-STAR ENERGY Scholars award, regardingeligibility, including the application process is available in the Magister Program inGeothermal Technology of ITB website at www.geothermal.itb.ac.id and Star Energywebsite: www.starenergy.co.id

Information as depicted below is important and required for applying

application. Section A contains your personal details and ended with

Section K with a declaration of validity and legality of all the information

you have stated. Please be sure to complete all the fill-in form correctly

for any misleading information is a serious offence under law of ITB and

will result in the ITB withdrawing a scholarship, if offered.

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SECTION A: PERSONAL DETAILS

Name(s)

as stated in your birthcertificate

Attach a recentphotograph of

yourself(3x4)

Full Name(s)

as stated in your birthcertificate

Gender (male or female)

Date of Birth (DD-MM-

YYYY)

Place of Birth

Please ensure you include your personal phone number and personal emailaddress, so that ITB can contact you if required.

Home Address

Postal Number

City/Province

Home Telephone Number

Mobile TelephoneNumber

Email Address

Work Address (if you areemployed)

Job Title

Work Telephone Number

Name someone whom we can ask regarding to your intentions in applyingthe scholarship program. Make sure that someone listed below is he/shewho can give answer regarding your application. You can name yourformer lecturer, employer, or relative families.

Name of Your Reference

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Relationship

Telephone Number

SECTION B: PROPOSED STUDY PROGRAM

Magister Program in Geothermal Technology of ITB has two field of study,specialization in Engineering and Exploration. To ascertain which fits toyour qualification and interests, please visit our website atwww.geothermal.itb.ac.id to have more detailed information related eachspecialization offered as there is a specific requirement regardingprevious educational background (undergraduate background).

Please thick the appropriate boxes (Note: You are not permitted to make changes ifyour application is accepted).

Exploration

Engineering

SECTION C: ENGLISH LANGUAGE PROFIENCY

If you have completed an IELTS or TOEFL (no more than 12 months ago),please attach the certified test result.

IELTS/TOEFL Test TotalScore

IELTS/TOEFL Test Date

SECTION D: ACADEMIC POTENTIAL TEST

Academic Potential TestScore

Academic Potential TestDate

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SECTION E: ACADEMIC BACKGROUND

Please state your academic background history from high school level.

Title of Program(e.g. PetroleumEngineering orSMU or SMK)

AwardingInstitution

(e.g. ITB, UI,etc.)

Period ofEnrollme

nt

Completed, Yes or

No?When?

GPA(min.3.25)

AcademicDegree (e.g.Ir, ST, or S.Si)

List any scholarship you have previously received, including thedonator/organization name, duration of qualification/course undertaken,and the date completed.

Donator/organization name

Name of qualification/courseundertaken (including the

city/country the course took place

Duration and the datecompleted

SECTION F: PRIOR RESEARCH

Have you undertaken any research or has any of your work published?

Yes

No

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If yes, please state the title of your research or published paper and nameof the publisher (including the website address if any)

.

.

.

Please provide a brief summary of that research (you may attachsupporting document if required)

.

.

.

.

.

.

.

.

.

.

.

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SECTION G: EXPECTED OUTCOMEFROM STUDYING INGEOTHERMALTECHNOLOGY OF ITB

Please be as specific as possible as your answers to these questions willbe a major consideration of your eligibility for a USAID-STAR ENERGYScholars award.

Describe the specific skills and knowledge you want to gain from your proposedstudy and how this study will contribute to the role and responsibilities of yourcurrent and/or future job (maximum 500 words).

SECTION H: ORGANIZATIONAL EXPERIENCE

Organization Role or type of involvement

Start date (month/year)

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SECTION I: WORK HISTORY (IF YOU ARE/WERE EMPLOYED)

This section covers your work history and current work situation.

Current position title

Organization/Category

Start Date (month/year)

Brief Description of yourcurrent job

Will you return to yourcurrent job after yourstudy?

Yes

No

Work History 1

Position title

Name of theCompany/Category

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Specific Responsibilities

Work History 2

Position title

Name ofCompany/Category


Specific Responsibilities

SECTION J: EMPLOYER ENDORSEMENT

If you are still working by the time the application submitted, you mustcomplete this section. This section must be filled in by your employer.

Endorsed by Company

Telephone Number

Email Address

State the reasons why you

recommend this applicant

Describe the specificqualification or skills youexpect this applicant togain from studying

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Magister Program inGeothermal Technology ofITB

SECTION K : USAID STAR ENERGY AWARD APPLICANTS DECLARATION

1. I confirm and declare that the information submitted with this application istrue and complete.

2. I acknowledge that giving false or misleading information is a serious offenseunder the criminal code and will result in the ITB withdrawing a scholarship, ifoffered.

3. I understand that at the time of enrollment I will be required to supplyoriginals of all documents used to support this application.

Full Name

Signature

Date

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Documents

USAID STARENERGY Scholarship Application 2013