1/22/2021 EP-Nuffic - Delta - Candidate application

With this form you can apply for a StuNed scholarship program managed by Nu c Neso Indonesia.
The careful handling of your personal data is very important to us. Please see this privacy statement for
more information. privacy statement (https://www.nu c.nl/sites/default/ les/2020-08/privacy-
statement.pdf)

Personal Information

Surname 

First name (optional)

Gender

Nothing selected

Place of birth

Date of birth

DD/MM/YYYY 

National ID card (KTP) number

Email

Email2 (optional)

Address City

Address Street and number

Address Zip code

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Province (optional)

Nothing selected

Country

Nothing selected

Telephone Number (phone) (optional)

Cell phone

Emergency Contact Detail

Emergency contact name

Emergency contact relationship with applicant

Emergency contact email

Emergency contact phone number

Program

Course 

Nothing selected

Name Contact person/supervisor

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Email contact person/supervisor

Undergraduate Education

Name of previous study programme

Institution of previous education

Country of previous education

Nothing selected

Graduation year

GPA

Postgraduate Education and Training

Name of postgraduate study program (optional)

Institution of postgraduate education (optional)

Country of postgraduate education (optional)

Nothing selected

Graduation year postgraduate education (optional)

GPA postgraduate education (optional)

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English Language Pro ciency

Test type 

Nothing selected

Test score

Test date

DD/MM/YYYY 

Present Employment

Name of employer institution (optional)

Department/directorate at the current institution (optional)

Current position (optional)

Tasks and responsibilities (optional) 

Position held since [...] (optional)

DD/MM/YYYY 

Employed from [...] (optional)

DD/MM/YYYY 

Employment for [...] hours per week (optional)

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Employer address (optional)

Employer city (optional)

Employer Province (optional)

Nothing selected

Employer o ce Phone Number (optional)

Employer o ce Email Address (optional)

Employer o ce Website (optional)

Brief description of your institution (optional)

Previous Employment

Previous employer Name (optional)

Previous employer Address Line 1 (optional)

Previous employer Address Line 2 (optional)

Previous employer Period of Employment (optional)

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Previous employer Position (optional)

Previous employer Describe duties and responsibilities (optional)

Awards, Publications and Community Involvement (maximum

4000 characters)

Award (optional) 

Publication (optional) 

Community involvement (optional) 

Co Funding

Co-funding sources (optional)Click to add an option

Nothing selected

Other funding source (optional)

Form of contribution (optional)Click to add an option

Nothing selected

Other form of contribution (optional)

Additional question

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For which other scholarship programme(s) are you also applying at this moment? (optional)

Document Upload Section

Copy of passport 

Choose le

You can only upload PDF les (max. 5MB)

Academic Transcript and Certi cate + English Language pro ciency + Unconditional O er letter 

Choose le

You can only upload PDF les (max. 5MB)

Employer Statement + Motivation letter 

Choose le

You can only upload PDF les (max. 5MB)

Co-funding statement (if applicable) (optional) 

Choose le

You can only upload PDF les (max. 5MB)

Other supporting docs such as awards, other certi cate (optional) 

Choose le

You can only upload PDF les (max. 5MB)

I certify that all my answers are true, complete and correct and that I comply with the conditions in
this document applicants's declaration (https://www.nesoindonesia.or.id/beasiswa/stuned/stuned-
application-documents)

Submit application

Version: Delta v1.6.51.0

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