KEDUTAAN BESAR REPUBLIK INDONESIA QUITO

KEDUTAAN BESAR REPUBLIK INDONESIA QUITO

No.

3 Of

/PENSOSBUD/XII/2013

Señor Secretario General Instituto Ecuatoriano de Crédito Educativo y Becas De mi consideración: Luego de enviar mis más calurosos saludos, tengo el honor de informar sobre el programa de becas DARMASISWA el cual es un programa ofrecido por el Gobierno de Indonesia a estudiantes extranjeros de países que tienen relaciones diplomáticas con el país para estudiar el idioma Bahasa (indonesio), música tradicional y artesanía indonesia. El candidato podrá decidir de entre 46 universidades escogidas, la institución de más alto nivel que tenga este programa. La Embajada de Indonesia tiene el honor de comunicar que este programa de becas está organizado por el Ministerio de Educación y Cultura en cooperación con el Ministerio de Relaciones Exteriores de Indonesia. Para conocer la información completa en relación al proceso de postulación y los requerimientos, se solicita amablemente que se consulte el documento adjunto a la presente o a la página web oficial del programa: http://darmasiswa.kemdikbud .go.id. A continuación se comunican los datos de la Embajada de Indonesia en QuitoEcuador para resolver cualquier duda: Dirección: Av. Portugal E 12-33 y Francisco Casanova Teléfono: (02) 2453260 E-mail: [email protected] Ruego a su persona poner este programa en conocimiento de las Universidades del país y aprovecho esta oportunidad para reiterar las seguridades de mi más alta y distinguida consideración .

Quito, 23 de diciembre de 2013

Ministro Consejero

INTRODUCTION DARMASISWA INDONESIAN SCHOLARSHIP PROGRAM ACADEMIC YEAR 2014/2015

Darmasiswa Rl program is a scholarship program offered by the lndonesian government to foreign students from countries which hove diplomatic relationship wirh Indonesia to study Bahasa Indonesio, troditionol music, troditionol dance, ond lndonesian craft. The candidate is allowed to decide the higher institutions (un iversities ) which carry out the program. DARMASISWA is a non-degree scholarship program offered to all foreign students from countries which hove diplomatic relationship with Indonesia to study Bahasa Indonesia, arts, music, crafts and particular subject in 46 selected lndonesian Higher Education lnstitutions in different cities in Indonesia. This program organized by the Ministry of Education and Culture (MoEC) in Cooperation with Ministry of Foreign Affairs (MoFA}. The main purpose of the Darmasiswa program is to increase and foster interest in Bahasa Indonesia and lndonesian culture among c itizens from other countries. lt has also beeri designed to enhance mutual understanding and provide stronger cultural link among different countries. The interest of international students to participate in this program keep increasing year by year, especiafly in the last five years as can been seen as the following table. Darmasiswa Scholarship Program is conducted in two schemes, i.e:

l.

PROGRAM OFFERED

1. Regular 1 (One) Year

Regular One Year program is one-year scholarship program offered to foreign students who would like to study Bohasa Indonesia, traditional music, traditional dance. traditional cratt and other particular subjects*) in selected lndonesian Hrgher Educotion lnstitutions.

2. Regular 6 (Six) Months Regular síx-month program is six-month scholo rship program offered to foreign students who woul d like to study Bahasa Indonesia in selected lndonesian Higher Educotion lnstitutions. Pagel of 4

1

.·..:.

11. SCHEDULE OF PROGRAM

l. 2.

3. 4. 5.

Reqistration Selection Announcement Confirmation Commencement a. On e year proqram b. Six m o nth proqram

9 Dec 2013-24 January 2014 3 Feb- 28 March 2014 April 2014 1 -20 May 2014 Sept 2014- Februarv/ AQustus 2015 September 2014- July 20 15 September 2014- February 2015

' 1

Note : Ministry of Educo tion ond Culture (MoEC) , Ministry of Foreign A ffo irs {MoFA), Hig her Educ o tion (HE)

111.

VISA ARRANGEMENT The Darmasiswo student is required to hove o Social Visit Visa (VKSB) for 60 do y!> issued by the lndonesian Embassy in the student's country of residence. Upon arrival in Indonesia, the Darmasiswa student's passport has to be submitted to · the Bureau of Pfanning and lnte rnationol Cooperation, Ministry of Education ond Culture, for necessary arrangements in obtoining recommendations of the State Secretadat ond the Directorate Gen eral of lmmigrotion, Ministry of Law ond Human Ríghts. The students are prohibited to apply for Tourist Visa or On-Arrival Visa for study purpose.

IV.

COVERAGE OF SCHOLARSHIP Monthly allowance will be receiv e d by student is Rp 2.000.000,00 (two million rupiah}. o. b. c. d. e.

: Rp. l .200.000 Living Cost : Rp. 200.000 Book Allowonces : Rp. 200.000 Local Transport Medicai/Heo lth Core : Rp. 200.000 : Rp. 200.000 Pocket Money

The student is advised to brin g enough money in US doflor for unexpecte d additional e xp e nses in Indonesio.

Page 2 of 4

V.

QUALIFICATIONS OF STUDENTS

Each stu de nt has to fulfill these requirements as the follows: o . Not more tha n 35 ye ars of age. b. Completed seco ndary ed ucation or its equiva le nt c . In goo d hea lth os prov e d b y Medico! Certific ate d. Able to communicate in English and additional Bahasa Indonesia is required e. Hove basic knowledge of the fi e ld yo u're applying for.

VI.

1

PROCEDURES

The applicant should registe r throug h th e following proc edures : Prospective stu dents are req uire d to register a t the Em bossy 1 C onsulate General in the country of origin of students, and for students who a re no t in the stud e nt' s home country is not allowed to be registered through the lndon esio n Embassy/Consulate General in the participoting countries [non-citize nship) .

VIl. APPLICATION REQUIREMENTS Student must submit a comple te application package that includes all the following items: a. Completed admission application form b. Recommendation letter from Higher Education lnstitution c. Copy of academic transcript and certificates d. Copy passport vatid at least 18 months from time of arrival in Indonesia. e. Currículum vitae/resume f. Passport size color photograph {5 pieces)

All documents must be submitted to lndonesian Embassy/Consulate General rn resídence to be selected; afterward lndonesian Embassy/Consulate General will send the selected documents to: Darmasiswa Scholarship Secretariat Head of Bureau of Planning and lnternational Cooperation Secretariat General Ministry of Education and Culture C Building, 6th Floor Jalan Jenderal Sudirman, Senayan, Jakarta Telp./Fax. (+62-21) 5724707, 5738181 Website: http://darmasiswa.kemdikbud.go.id email: [email protected]

Page 3 of 4

1 7(32.

!. )

VIII.

ACCOMODATION

The Ministry of Education ond Cultural doesn't provide the occommodotion for students.

IX.

ARRIVAL IN INDONESIA

The Ministry of Education and Culture does not provide the return lnternational airfare to fndonesia. We only provide the transportatlon from Jakarta to place of study; however the transportation from place of study to Jakarto wi!l be carried out by students. X.

HEALTH INSURANCE The Ministry of Education ond Culture (MoEC) will not provide health insuronce; therefore the students are expected to hove the lnternotional in surance.

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

1

Page 4 of 4

1

-

REKAPITULASI KUOTA PER LEIVl BAGA PERGURUAN TINGGI PROGRAM DARMASISWA Rl TAHUN AKADEMIK 2014/2015

lEMBAGA PERGURUAN TJNGGJ

NO

2014

1

Universitas Negeri Medan (UNIMED)

12

2

Universitas Andalas (UNAND)

12

3

!SI Padang Panjang

12

4

Universitas Sriwijaya (UNSRI)

12

5

Universitas Bina Darma Palembang

8

6

Universitas Lampung (UNILA)

10

7

Universitas Indonesia (UI)

12

8

Universitas Negeri Jakarta (UNJ)

12

9

Universitas Nasional (UNAS)

12

10

STP Sahid

8

11

STBA LIA Jakarta

10

12

Universitas Katholik Atmajaya Jakarta

10

13

UIN Syarif Hidayatullah Jakarta

8

14

Universitas Padjadjaran (UNPAD)

12

15

STSI Bandung

20

16

Universitas Pendidikan Indonesia (UPI)

12

17

Universitas Pasundan {UNPAS)

12

18

lnstitut Teknologi Bandung (ITB)

12

19

Universitas Komputer Indonesia Bandung

8

20

STISI Telkom Bandung

8

21

Universitas Diponegoro {UNDIP)

12

22

Universitas Negerí Semarang

12

23

Unika Soegijapranata Semarang

12

24

Universitas Gadjah Mada (UGM)

10

25

Universitas Negeri Yogyakarta (UNY}

12

26

1$1 Yogyakarta

30

27

Universitas Ahmad Dahlan Yogyakarta (UAD)

12

28

Universitas Sanata Dharma Yogyakarta

12

29

P4TK Kesenian Yogyakarta

20

30

Universitas Katho!ik Atmajaya Yogyakarta

12

REKAPITULASJ KUOTA PER LEMBAGA PERGURUAN TINGGI PROGRAM DARMAS!SWA Rl TAHUN AKADEMIK 2014/2015

LEMBAGA PERGURUAN TINGGI

NO

2014

31

Un iversitas Sebefas Maret Sura ka rta

12

32

151 Surakarta

30

33

Uníversitas Muhamm adiyah Surakarta {UMS)

12

34

Universitas Negeri Surabaya

12

35

Un iversitas Airlan gga Surabaya {UNAIR}

12

36

Universitas Muhammadiyah Surabaya

10

37

UK Petra Surabaya

12

38

Universitas Surabaya {UBAYA)

12

39

ITS Surabaya

12

40

Universitas Negeri Malang

12

41

IKIP Budí Utomo Malang

12

42

Universitas Muhammadiyah Malang

12

43

Politeknik Negeri Malang

12

44

P4TK Malang {VEDC Malang)

12

45

Universitas Udayana

12

46

ISI Denpasar

30

47

IKIP Saraswati Tabanan

10

48

Universitas Pendidikan Ganesha (UNDIKSHA)

12

49

Politeknik Negeri Bali {POUBAU)

12

50

Universitas Mulawarman, Samarinda

12

51

Universitas Muhammadiyah, Makasar

12

JUMLAH

650

Siro PKLN, Kemdíkbud

LIST OF UNIVERSITIES ANO COLLEGES ORGANIZING IN THE R E GULAR 1 (ONE) YEAR, REGULAR 6 (SIX) MONTH PROGRAM

E]

HIGHER EDUCATION INSTITUTION

ADDRESS 1

JI

MAJOR

1

PROGRAM

1

Medan State University (UNIMED)

W illem lskandar Psr V, Medan Estate, Medan Telp . (061) 6613365 Fax. (061)6613319 Web: www.unimed .ac.id

Andalas University (UNAND), PADANG

Rektorat Unand Kampus Manis Padang Telp. (0751) 71303 Fax. (0751) 71085 Web: www.unand .ac.id

· Bahasa Indonesia (lndon esian Language)

- Regulaí 1 Year - Regu lar 6 Month

lndonesian Art lnstitute of Padang Panjang {!SI Padang Panjang)

Bundo Kanduang 35 Padang Panjang, Sumatera Barat Telp. (0752) 82077 Fax. (0752) 82803 Web: www.isipadang panjang .ac.id

- Karawitan (Traditíonal Musíc) - Seni Tari (Dance) .- Sen i Kriya (Handicraft)

-Regular 1 Yea r

Sriwijaya University (UNSRI) , Palembang

Raya Prabumulih, lndralaya OKI, Palembang Telp. (0711) 580357 Web: www.unsri.ac.id

Bahasa Indonesia (lndonesian Language)

-Regular 1 Year - Regular 6 Month

University of Bina Darma, Palembang

JI. Jenderal Ahmad Yani No. 24, Palembang, 30264 Telp. (0711) 7080181 Fax. (0711) 513018 Web: www.binadarma.ac.id


- Regular 1 Year - Regular 6 Month

6.

Lampung University (UNILA)

Prof. Dr. Sumantri Brojonegoro No. 1, Bandar Lampung 35145 Te!p. (0721) 701609, Fax. (0721} 702767 Web: www.unila.ac.id



7.

University of Indonesia (UI) , Jakarta

Kampus U!, Depok 16424 Jawa Barat Te! p. (021} 7270009, 7863528, 7863529, 7864075, Fax. (021) 7270038 Web: www.ui.ac.id



Jakarta State University (UNJ)

Rawamangun Muka, JKT 13220 Telp./Fax. (021) 4893982 Web: www.unj.ac.id


Nasiooal Un iversity (UNAS), Jakarta

Sawo Manila, Pejaten, Pasar Minggu , Jakarta 12520 Tefp. (021) 7806700 Fax. (021) 7802718/19 Web: www. unas .ac.id

Bahasa Indonesia (lndonesian

D D 3.

D

D 8.

D



1

1Language)

i

[ - Regular 1 Year - Regu lar 6 Month

i

~~- Regular 1 Year

Ji- Regular 6 Moo th

~

11(~2..

DI 11.

LIA lasUtute of Fore1gn Language (STBA LIA)

University of Atmajaya Jakarta (UN!KA ATMAJAYA JAKARTA)

14.

51, Jakarta Selatan 12930 Telp. (021} 57276 15, 5703306 Fax Ext. 251 (021 ) 5747912 Web: www.atmajaya.ac.id


-Regula; 1 Ye a;

. - Reg ular 6 Month

¡-

Regular í ~~ - Regul ar 6 Month

Jalan Kem iri No. 22 Pondok Cabe, Pamulang, Jakarta Telp. (021) 7402329 Ext. 24 Fax. (021)7428152 Web: www.stpsa hid.ac.id

Ku liner (Culinary)

- Regu lar 1 Year - Regular 6 Month

State lslamic University (UIN) of Syarif Hidayatullah , Jakarta

JI. H. Juanda No. 95 Ciputat, Tangerang Selatan, Banten Telp. (021) 7401925 Fax. (021)7401925 Web: www.uinjkt.ac.íd

!slamic Studi es in Indonesia

- Regular 1 Yea r - Regular 6 Month

Padjadjaran University (UNPAD), Bandung

Jalan Dipati Ukur No. 35 Bandung - Jawa Barat Telp. (022) 2501977 Fax. (022)2501932 Web: www.unQad.ac.íd

Bahasa Indonesia (!ndonesian Languag e)


Education University of Indonesia (UPI) Bimdung

Dr. Setíabudi No. 229 Bandung - Jawa Barat Telp. (022) 213162 Fax. (022) 213651 Website: http://www.upi.edu

Bahasa Indonesia (lndonesian 1 Language)


Buah Batu No. 212 Bandung 40265 Telp. (022) 7314982 Fax. (022) 7303021 Web: www.stsi-bdg.ac.id

- Karawitan (Traditional Music) - Seni Tari (Dance) - Sení Musik (Traditiona! Music)

- Regular 1 Year

University of Pasundan (UNPAS) Bandung

Tamasari 6-8, Bandung Telp. (022) 4201677, 4205832 Web: www.unQas .ac.id

Bahasa Indonesia (lndones ian Language)

- Regular 1 Year - Regu lar 6 Month

Universitas Komputer Indonesia (UNIKOM) Bandung

Dípati Ukur 102 Bandung 40132 Telp. (022) 250 3054 Fax. (022) 253 3754 Web: www.unikom .ac. id

Uníversitas Telkom (Telkom University)

J I. Soekarno Hatta No. 581 Bandung 40275 Telp. (022) 730 6211 Fax. (022) 7333 250 Web: www.stis ítelkom .a c. id

D D

College of the

lndonesian Art (STSI) Bandung

D '1'8."

1Jalan Jenderal Sudirman No.

J

Sahid !nstitute of Tourism (STP SAHIO) JAKARTA

D ~

Jalan Pengadegan Timur Raya ' Bahasa Indonesia (ln donesian No. 3, Jakarta Selatan 12270 Telp. (02 1) 79181051 Language) Fax. (021)79181057 Web: www.stba lia.net

u

JI.

118

-Teknik Komputer · (Computer Technology) - Sistem lnformasi . - Akuntansi · (Accounting)

- Regular 1 Year

-Visu al Commun ication Design - Textile & Model - Art Desiqn


!

2

20.

lnstitute of Technology Bandung (ITB)

l

21 .

Band ung

- Architecture, Landscape, and Urban Design - Art and design (design studio and workshop) - Biodiversity (scientific food and medicine)


Prof. H. Soedarto, S.H. Tembalang, Semarang Kotak Pos 1269 Telp . (024) 7460012 Fax. ((024) 7460013 Web: www.undip.ac.id

Ba hasa Indonesia (lndon esian Language}

-Regular 1 Yea r - Regular 6 Month

State University of Semarang (UNNES)

Ka m pus UN NES Gedung H, Sekaran Gunungpati Telp. (024) 8508004 Web: www.unnes .ac.id

- Bahasa Indonesia (lndonesian Language) - Seni Batik (Batik Art)

- Regular 1 Year - Regular 6 Mooth

Teacherand Educational lnstitute of PGRI Semarang (IKIP PGRI Semarang)

Kampus 1 : Lontar No. 1 (Sidodadi Timur) Semarang Kampus 11: Lingga Raya No. 1 Semarang Telp. (024) 8448217, 8316377 Fax(024)8448217 Web: www.ikip-pgrismrg.net



~

24.

JI. Pawiyatan Luhur IV/1 Soegijapranata Catholic University of Bendan Duwur Semarang · 50234 Semarang (UNIKA . Telp. (024) 8441555 Fax. Soegijapranata, (024)84452656,8415429 Semarang) Website: www.unika.ac.id

- lndonesian Traditional Herbal Medicine - Enterpreneurship and Social Responsibility


25.

lndonesian Art lnstitute of Yogyakarta (ISI) Yogyakarta

- Seni Kriya (Handicraft) - Seni Tari Tradisional (T raditional Dance) - Karawitan (Traditional Music)

- Regular 1 Year

Bahasa Indonesia {lndonesian Language)


1Bahasa lndones;a


University of Gadjah Ma da (UGM) Yogyakarta

D 27.

State University of Yogyakarta (UNY)

Parangtritis Km. 6,5

0.1. Yogyakarta Telp./Fax. (0274) 371233 Websíte: http://www.isi.ac.id

Bu!aksumur

0.1. Yogyakarta Telp . (0274) 563974 Website: http://www.ugm.ac.id Karangmalang, 0.1. Yogyakarta Te/p. (0274) 586168 ext 318 Fax. (0274)565500 WebsJte : htt:/WVN1.uny:.ac.id

¡

(lndonesian , Language}

' ..

Diponegoro University (UNDIP} Semarang

o 23.

JI. Ganesha 1 O, 40132 Telp. (022) 2500935 Fax. (022)2500935 Web: vvww.itb.ac.id

'

1 3

t6(32.

University oí Sanata

Df= D D

f'v l ri ca n Tromol Pos 29

Bahasa Indon esia

0

-

Regul ar 1 YeEJr

Ahmad Dahlan University (UAD) Yogyakarta

Fax. (0 274) 562383 Web: www.uad.ac.id

Jalan Kapas No. 9, Semaki, Yogyakarta Telp. (0274) 511829 Fax. (0274)564604 Web: www.usd .ac.id

- Bahasa Indonesia (lndonesian Language)

- Bahasa Indonesia Universrty of Jalan Babaran No. 44, (lndonesian Atmajaya Yogyakarta Yogyakarta 55281 Language) (UN IKA ATMAJAYA 1Telp. (0274) 487711 1 YOGYAKARTA) Fax. (0274) 487729 W eb: www.uajy.ac.id ~~~~~~~~~ 31 . Teacher Training Jalan Kaliurang KM. 13,3, - Se ni Tari Center and Klidon Sukoharjo Ngaglik (Dance) Slem an , Yogyaka rta 5581 - Karawitan Development of Art (Traditional Music) and Culture (P4TK) Website : - Seni Batik (Batik Yogyakarta Http ://www.pppgkes.com

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6

f" 'uh~ " ;" )" ~" 'o" 'g" y" a" 'ka" rt" a=~!,~;,;~.; I~;:,Y;~,;O~~ªa7~~~~:g;§;~ §3Sª'1~·~51" 5"3""'5""2=~~L""''~,-~,~,=,=,=,~~,n===~l¡- Regular~ 1

Month

1


-Regular 1 Year - Regular 6 Month ,

-Regular 1 Year

Art) - Pedalangan (Puppetry) 32.

lndonesian Art lnstitute (ISJ) Surakarta

.Ki Hajar Dewantara No. 19, Surakart9 Jawa Tengah Telp. (0271) 476~8 Fax. (0271} 46175 · Websíte: http://www.stsi-ska.ac. id

- Seni Musik Tradisiona l (Traditional Music) - Seni Tari (Traditional Dance) - Etnomusikologi ( Etnomusicology) - Pedalangan (Puppetry)


33.

University of Sebelas Marel (UNS) Surakarta

Ir. Sutami No. 36 A. Surakarta Telp. (0271) 469f.l4 Fax. (0271} 46655 Web: www.uns.ac.id



Muhammadiyah Universíty of Surakarta (UMS)

Komplek Pondok lnternasionál KH Mas Manshur, JI. A Yani Tromol Pos 1, Papelan, Surkarta 57102 Telp. (0271) 7653115 Fax. (0271) 715448 Web: intemational.ums.ac.id



State University of Malang (UM) Mafang

Surabaya No. 6 Malang - Jawa Tirnur Telp. / Fax. (0341) 551312 Website: www.malang.ac.id

Bahasa Indonesia (lnd one sian Language)


=34.

D

4

14(32

-Regu lar 1 Year - Regular 6 Mon th

Simpang Arjuno 14 B Malang Telp. (034 1) 326019, 3232 14 Fax. (0341) 326019 Web: www .ikiQbud iutomo.ac.id

Malang Muhammadiyah University (UMM)

Jalan Raya Tlogomas 246 Malang Telp. (034 1) 464318/19 Faks. (0341)460782/460345 Website: www.umm .ac.id

Vocational Education Developmen t Center (P4TK) Teknologi Malang

Jalan Telu k Mandar Arjosari Tromol Pos 5, Ma!ang 65102 Telp. (0341) 491239 Website: http://ww.v.vedc malang.com

39.

State University of Surabaya (UN ESA)

Kampus IKIP, Surabaya Ketlntang Surabaya - Jawa Timur Telp (031) 8290357 Website: htt[2://www.unesa.ac.id


-Regular 1 Year -Regu lar 6 Month

40.

Airlangga University (UNAIR) Surabaya

Kampus C Mulyorejo, Surabaya 60115 Telp. (031) 5914042, 5912546 Fax. (031) 5981841 Website: http://www.unair.ac.id

- Bahasa Indones ia (l ndonesian Language)


Muhammadiyah Universíty of Surabaya (UNMUH Surabaya)

Sutórejo No. 59, Surabaya Telp. (031) 3811966 Fax. (031) 3813096 Website: www .. ac.id



42.

Petra Christian University, Surabaya

Jalan Siwalankerto 121-131, Surabaya Tetp. (031) 8439040, 849483031, ext. 1150,1151 Fax. (031)8492583 Web: petra.ac.id

- Bahasa Indonesia (lndonesian Language) - Chinese lndonesian Architecture Design - Photography Chinese lndonesian Tradition


43.

University of Surabaya (UBA YA)

lnternational Village, Raya Kalirungkut, Surabaya 60293 Telp. (031) 298-1 300 Fax. (031) 298-1301 www.ubava.ac.id



37.

D LJ

t

! -Bahasa Indonesia

j Teacher and Educational ln stitute of Budi Utomo Malang (IKIP Budi Utomo Malang )

36.

¡ (lndonesian

Language)

Bahasa Indonesia ( lndonesian Language)

~ Bahasa Indonesia

-Reg ular 1 Year - Regular 6 Month

-Regular 1 Year

(lndonesia n Language)

t

5

15/3.2.

-

lndones ian Art lnstitute (I SI) Denpa sar

Nusa lndah Denpasar- Bali Telp. (0361) 2273 16 Fax. {0361) 233100 Website: http://www.isi-dps.ac. id

· - Seni Mus ik (Traditional Music) - Sen i Tari (Traditional Dance) - Seni Kriya (Handicraft) - Karawitan (Traditional Music)

- Regular 1 Year

University of Udayana (UNUD) Balí

Komplek Kampus Jimbaran Den pasar Telp. (0361) 701 954 Fax. (0361) 701907 Website : httQ://www.unud.ac.id



GANESHA Education University (UND!KSHA) Singaraja, Ba!i

Achmad Yani No. 67, Singaraj a, Balt, 81116 Telp. (0362) 23458 Fax. (0362) 25735 Website : httQ://www.undiksha.ac.id

Ba hasa Indonesi a (lndonesian Language)

-Regula r 1 Year - Regular 6 Mo nth

47.

Polytechnic of Bali (POLI BALI)

Kampus Bukit Jimbaran KutaBali, P.O . BOX. 1064 Tuban Te!p. (0361} 701981,703215, Fax. (0361) 701128 Website :www.pnb.ac.id

- Pariwisata (Tour, Travel and Hotel Management)


48.

Teacher and Educational lnstitute of Saraswati Tabanan, Bali (IKIPSaraswati Tabanan)

Pahlawan No. 2, Tabanan 82113 Telp. (0361) 811267 Fax: (0361) 811267 Web: www.ikiQsaraswatitabanan.com

Ba hasa Indonesia (lndonesian Language)

-Regular 1 Year -Regu lar 6 Month

49.

Mulawarman University (UNMUL), Kalimantan Timur

Kampus Unmul Gunung Kelua Kotal< Pos 1068 Samarinda Telp. (0541) 748698 Fax. (0541)747479 Web: www.unmul.ac.id



Makasar Muhammadiyah University (UNISMUH Makasar)

Sultan Alaudin No. 259, Makassar Telp. (0411) 881593 Fax_ (0411)865588 Web: www.unismuh .ac.id


~ Regula r 1 Yea r - Regular 6 Month

Sepuluh November lnstitute of Technology (ITS)

Kampus ITS Keputih, Sukolifo, Surabaya 60111. Jawa Timur Telp. (031 ) 5994251 , 5947264 Fax. (031) 5923465 Website: www.its.ac.id

- Bahasa Indonesia (lndonesian Language) - Technical Environment - Architecture

Regular 6 Month

44.

D 46.

~

D 51.

Bureau of Planning and lnternational Cooperation Ministry of Education and Culture

6

M!N I ST RY OF EDUCATION AND CULTURE THE GOVERN MENT OF THE REPU BLICOF INDONESIA Ja la n J e nde ra l Su di rma n - Sen aya n, Jaka rta

Phone/ Fax: ( + 6 22 1) 5724707, 5711 144 ext. 2610 Website: darmasiswa.kemdikbud.go. id Email: darmasiswa _ [email protected]

DARMASISWA SCHOLARSHIP PROGRAM APPLICATION FORM

A. PERSONAL INFORMATION Family Name: _ _ _ _ __ _ _ _ _ _ _ _ _ _ __ _ __ _ _ __ _ N ame: M r/M rs/Ms - - - - - - - - -- --

-

----------

affix photo here Citizenship: - - - - - - -- - - -- - - - - - - - --

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Relfgion : - - - - --

-----

4 X 6 cm - --

Place and date of birth: -

-

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

- - - - --

- - -- -- -- --

- --

Passport Number: _ _ _ _ __ _ _ _ __ _ _ Valldity of _ __ _ _ __ Mailing Address: - - - - - - - -- - --

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

- - --

-

-

-

- - - --

- --

- -- -

- - - - - - ~ (Home)/Cell-phone: - - - - - - - -

':il(Office): _ _ _ _ _ _ _ _ _ Fa x: - - - --

Marita l status: O Single

- - - - - - --

- - --

Emo il: - - --

- - -- - - -- - -

O M o rried (opproved by c opy of morrioge certifico te )

Do you hove a husband/wife or any d e p endants? (Pieme give de foils bf na me. rela tionship and d ate o f birth)

Name

No

Relatlonship

Wh e re do y o u p refer fo r stay? (l f yo u choose homestay. p ie ose Ell oul Jhe hornes t:Jy o.oplico !ion lorm¡

O Hom e stay

O Boarding

House

O Dormito ry Page 1 o f 5

'r/32.

1

Person to be notified in your country and in Indone sia in case of emergency: / ln Indon esia

In your country

Name: - -- - - - - - - - - - - - - - - Address: - - - - - - ---- - -- - - - - --

1

Narne: _____________________________________

1

Address: ___________________

1

Home/Cell Phone: - - - - - - - - - - - -- - - - -

Home/Cell Phone: ________________

Relationship:_ _ _ _ _ _ _ _ _ __ _ _ __

Relationship:._ _ _ _ _ _ _ _ _ _ _ _ _ __

¡

B.

ACADEMIC BACKGROUND**

Unlversily/lnstilute Attended alter High School

Years Attend ed

Degree Obloined/Exp ected

From

(lncl. Fle!d ol Srudyl

To

GPA

Academ!c Referees Please provide lhe nomes ond address of ot teost 2 persons you've asked lo forward con fldentiol reterences to the scholarship office. One of these referees mus! be eilher your proposed Chief Supervisor ora member of ocademic stoH at lhe institution ot where you oblained the entry quolificotion. Those references (ldealty on letterheod paper) must be attached.

Title and Name of Refere e 1: - - - - - ' - - - - - - - - - - - - - - - - - - - - - - - - - - - Address:._______________________________________________________________ Phone:____~-----------------Email:._ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __

Title and Name of Referee 2: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ Address:. _________________________________________________ Phone:. ____________________ Email :._ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __

language: State profíciency Fair-Good-Advonce

~

No

t

1

Bahasa Indonesia

2

English

Speaking

Understandlng

Writing

1 1

3

Other:

1 i Page 2 of 5

1g /32-

C.

PROPOSED PROGRAM ANO FIELD OF

STUDY~*

(Check one progrom and su bject of study)

l.

Program

a.

l (one) Yeor

b.

6 (six) month

First Choice Place of Study Subject of Study

Second Choice Place of Study Subject of Study

2.

Outline your proposed field of study and indicote the practica! use to t e made of this study. 1f you are acquainted with the possibiliti es of study offered in Indonesia. list pf institutes or projects yo u propase to study or specific course you wish to attend.

(attach addiLnal pages)

Page 3 of 5

¡ 1 1

1

13/32..

.;:::-

D.

PRO FESSIO NAL BAC KGR OUND**

List your work experience since universily g rod uaiion. Storl with the mos t current one. Do tes (fo-From) Pos itio n No me of lnstitutlo n Respo n sib llity (indicofe month)

E.

SOCIAL AND COMMUNITY INVOLVEM EN T'"*

Ust p rofessionol, societoL fro temities or o ther orgonizotions in which you now hold m e mbe rship or in whic h you hove b een ac tive in the post. (lndicote if yov hove held a n elec tive office}: Yeor

Re spo nsib ifity

Posltion/Orgonizotio n

lf you hove ever troveled or lived outside Indonesia, pleose sp e cify dotes, countries and purpose** Dotes

F.

Covnfry

Purpose

HOW DO YOU LEARN ASOUT DARMASISWA SCHOLARSHIP PROGRAM

DNewspaper ads

DFriend

Owebsil e

Ooth e r: - -- - - -- - - - - - -- - - - - - -- - -- -

lf you ore current!y apply ing for other sch olarship p rogroms, pleose sp e cify program and status of your opplicotion Nem e ol Program

Type of Pro gram Ap p lied

Tim e Pe ri o d

Page 4 of 5

DECLARATION

1hereby certify that the informotion 1hove provided o n this application form and in ony attached materiols is occurote and true to the best of my knowledge and be!ief. ond 1 ogree to notify Ministry of Education and Culture (M oEC) of ony chonge in the above informotion or of ony further informotion thot might offect my e ligibiliry for considero tion as o prospective recipient of the Darmasiswa Scholorship oword .

·' • . 1 understond thot by completing this opplication form there is no assurance thot 1will be owarded o gront. 1 understond thot gront funds ore not sufficient to cover trove! o: support for my fomily ond 1will moke necessory orrongemen ts for th e living expenses in Indonesio. 1w i/1 not chonge either subject or place of study prior or upon orrivol in Indon esia. •

1will not involve myself in ony politicol octivities or doing criminols during my study in Indonesio.

•

1will not underloke ony work for profit or eorn living during my study in Indonesio.

•

1will not involve with ony drug troffic: active user or drug-seller.

•

1will not do ond perform immoral acts.

•

1 will not trove! out of Indonesia during the acodemic period ond not trove! out of Indonesia more than once.

•

! will not ollowed to bring the fomily during the study period even though at my own expense

•

1will not oltow performing octivities of o certoin ideologies or indoctrinotion.

•

1 fully responsible for my own luggoge/goods if its lost prior or upon orrival in Indonesia. Hove them in my honds custody.

•

1 hove to refrain myself from being pregnont ond being involved in drug traffic and abuses.

•

1occept to be sent bock to my country if l violote the said regulotions ond the stay permit regulotion in Indonesia.

•

1hove to abide by the regulotion of the government of Indonesia ond os well as the Host University.

Slgnature: - - - - - - - - - - - - - - - - Date: - - - - - - - - - - - - - - - - - - - - -

Note: ""'Pieose ottoch odditionol poges if necessory.

THI S FORM IS TO BE FILlED OUT COMPlETEl Y AND ACCURATEl Y. WE REGRE T INCOMPlETE APPLICATION WllL NOT BE CON SIDERm.

Page 5 of S

.. .. -

·- ---. --- ----·

·--~-

________ , ___ _ -~ - -

-- -- ---

....

-.. . ·-- -- . -·--- ------- -------.

. ...• - ~----------~-----

-.

------ ....

--- ...-

-~·.

···-· ----· ..... --- -- ·---

······--~---·--·

--·-···

. ..

MINISTRY OF EDUCATION AND CULTURE

THE GOVERNMENT OF THE REPUBLICOF INDONESIA Jalan ) e nde ral Sudirman- Senayan, Jaka rta Phon e/Fax: ( + 6221) 5724 707, 5711144 ext. 261 O Website : darm asiswa.kemdikbud.go.id Email: dam1asiswa _ [email protected]

HOMESTAY APPUCATION FORM

A. STUDENT PERSONALINFORMAT!ON

family Name: _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ __ First Name: Mr/Mrs/Ms - - - - - - - - - - - - - - - - - - - - affix photo here

Citizenship: - - - - - - - - - - - - - - - - - - - - - - - - Rellgion: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __

4 X 6 cm

Place and date of birth: - - - - - - - - - - - - - - - - - - - - Passport Number: _ _ _ _ _ _ _ _ _ __ _ _Validity of _ _ _ _ __ Mailing Address : - - - - - - - - - - - - - - - - - - - - - - - - - - --

---

- - - - - - - - - - - - - - - - - - - - - - - 'il(Home)/Cell-phone: - - - - - - - ~(Office): _ _ _ _ _ _ _ _ Fax: - - - - - - - - - Email: - - - - - - - - - - - - -

Marital status: O Single

O Married [approve d by copy of marriage c ertificate )

English abillty: O Low

O Good

B.

MEDICAL INFORMATION

1.

Do you hove any medical condition?

O Excelfent

O Yes

O No

lf Yes, please explain: _ _ _ _ _ _ _ __ _ _ __ _ _ _ _ __ _ _ __ _ _ _ __ 2.

Do you hove any allergies? (i.e. animals. medica tion, etc.)? O

Yes

O No

lf Yes, please specify: _ _ _ _ __ _ _ _ _ __ _ _ _ _ _ __ _ _ _ __ _ _ __

Pa ge 1 of 2

r~ 1

l.

2.

1 llFESTYLE O No

Do you like outdoor adivities? O Yes

lf Yes, please list those that interest you: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ __ Do you líke sports?

O

D Ye s

No

lf Yes, please list those that interest you: _ _ _ _ _ _ __ _ _ _~------------

3.

Do you enjoy cooking?

O No

O Yes

Other hobbies/things you like:_ _ _ _ __ _~-------------------

4.

What are your hobbies and interest? _ _ _ _ __ __ _ __ _ _ _ _ _ _ __ _ _ _ _ _ __

5.

Things you dislike: _ _ _ _ _ _ _ __ _ _ __ _ __ __ _ _ _ __ __ _ _ _ _ _ _ _ __

6.

What time do you usualfy go to bed? _ _ _ _ _ __ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __

7.

lndicate the personality/character that the best describe you? Oindependent Oshy and quiet O friendly and social O adoptable and flexible other_________________________________________

8.

What time do you usually go to bed? _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __

9.

Do you smoke?

O Yes

O No

10. Will you shore a home with someone who smokes? O Yes

O No

D. FOOD PREFERENCES

O No 1. Are there any foods thot you do not eat? OYes lf Yes, pleose list describe: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ 3.

Do you hove any food preference?

O No

O Yes

lf Yes, please specify (Vegetarian/No Pork/other}: _ _ _ _ _ _ _ _ _ __ _ _ _~-----

4.

Do you hove ony food ollergies? O Yes

O No

lf Yes, please speclfy: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _- _ _ _ _ _ __

Signature of applicant

Date

THIS FORM IS TO BE FILLED OUT COMPLEitl Y AND ACCURATELY. WE REGRET INCOMPLETE APPU CATlO N Wl l l NO T BE C ONS ID ERED .

Page 2 of 2

2.3(32

INSTITUTO ECUATORIANO DE CRÉDITO EDUCATIVO Y BECAS

Documento No. : IECE-SEG-2013-2933- E Fecha : 2013-12-23 16:52:51 GMT -05 Recibido por : Gabriela Alexandra Trujillo Aric< Para verificar el estado de su documento ingrese a http ://www. gestiondocumental. go b. ec con el usuario: "9998978662"

KEDUTAAN BESAR REPUBLIK INDONESIA QUITO

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