1. SGPP-Indonesia-Application-Form-January2017
SGPP-Indonesia Application Form
Please return this application form and required documents to:
By Email
To:
admissions@sgpp.ac.id
By Post (hard copy)
To:
School of Government and Public Policy (SGPP-Indonesia)
Jalan Anyar, Citeureup
Sentul – Bogor 16810
Indonesia
Should you need more information or assistance in completing the application form,
please contact our admission officer via email at admissions@sgpp.ac.id or telephone
at +62 21 2932 5345 (Monday – Friday, 9 AM – 15.30 PM)
Page 1 of 11
SGPP-Indonesia Application Form
PERSONAL INFORMATION
Salutation/
Title
(Please choose
one)
Mr Mrs Ms
Full Name
(First, Middle,
Last)
Gender
(Please choose
one)
Male Female n/a
Date of Birth
(DD/MM/YY)
City of Birth
Country of
Birth
Nationality 1
Nationality 2
(if any)
CONTACT INFORMATION
Primary Email
Address
Other Email
Address (if any)
Permanent Address and Contact
Address
City
State/ County
Postal/ Zip
Code
Country
Telephone
(Please include
country code)
Fax (Please
include country
code)
Page 2 of 11
SGPP-Indonesia Application Form
Mobile/ Cell
Phone
Mailing Address
Is the Mailing Address the same as your permanent address? YES NO
If NO, please complete the form bellow
Address
City
State/ County
Postal/ Zip
Code
Country
Telephone
(Please include
country code)
Fax (Please
include country
code)
Third Party Access
Would you like to allow third party access to your admission process? YES NO
If YES, please complete the form below
Name
Email
Relationship
to Applicant
ACADEMIC QUALIFICATIONS
Post secondary/ Graduate/ Undergraduate Education Information
Institution 1
Degree/ Title
Majoring in
Date of
Graduation
(MM/YY)
Start Date
(MM/YY)
Distinction
(if any)
Page 3 of 11
SGPP-Indonesia Application Form
Status
HELD PENDING
Name of
Institution
Web Address
of the
Institution (if
any)
City
Country
Institution 2
Did you graduate from a second institution or take a second course/ degree in the same
institution?
YES NO
If YES, please complete the form below
Degree/ Title
Majoring in
Date of
Graduation
(MM/YY)
Start Date
(MM/YY)
Distinction
(if any)
Status
HELD PENDING
Name of
Institution
Web Address
of the
Institution (if
any)
City
Country
Institution 3
Did you graduate from a third institution or take a second course/ degree in the same
institution?
YES NO
If YES, please complete the form below
Degree/ Title
Page 4 of 11
SGPP-Indonesia Application Form
Majoring in
Date of
Graduation
(MM/YY)
Start Date
(MM/YY)
Distinction
(if any)
Status
HELD PENDING
Name of
Institution
Web Address
of the
Institution (if
any)
City
Country
ACADEMIC REFERENCE
Your application must be submitted with a minimum 2 academic references. Please
complete the form below for the referees details. SGPP Indonesia will send an email to
each referee to confirm their references.
Referee 1
Salutation/
Title
Mr Mrs Ms
Full Name
(First, Middle,
Last)
Company/
Institution
Name
Position
City
Country
Telephone
(Please include
country code)
Email Address
Referee 2
Page 5 of 11
SGPP-Indonesia Application Form
Salutation/
Title
Mr Mrs Ms
Full Name
(First, Middle,
Last)
Company/
Institution
Name
Position
City
Country
Telephone
(Please include
country code)
Email Address
Referee 3 (Optional)
Salutation/
Mr Mrs Ms
Title
Full Name
(First, Middle,
Last)
Company/
Institution
Name
Position
City
Country
Telephone
(Please include
country code)
Email Address
PROFESSIONAL EXPERIENCE
As the programs at SGPP Indonesia are all designed for young, more or less
experienced professionals, previous work experience is an additional important
requirement for admission to SGPP Indonesia. Students are expected to have between
2 and 10 years of professional experience at the time of application.
Professional Experience 1
Job Title
Page 6 of 11
SGPP-Indonesia Application Form
Company
Name
Start Date
(MM/YY)
End Date
(MM/YY)
Country
Sector of
Activity
Job
Description
Professional Experience 2 (if any)
Job Title
Company
Name
Start Date
(MM/YY)
End Date
(MM/YY)
Country
Sector of
Activity
Job
Description
Professional Experience 3 (if any)
Job Title
Company
Name
Start Date
(MM/YY)
End Date
(MM/YY)
Country
Sector of
Activity
Job
Description
PROFESSIONAL REFERENCE
Your application must be submitted with a minimum 2 professional references. Please
complete the form below for the referees details. SGPP Indonesia will send an email to
each referee to confirm their references.
Page 7 of 11
SGPP-Indonesia Application Form
Referee 1
Salutation/
Title
Mr Mrs Ms
Full Name
(First, Middle,
Last)
Company/
Institution
Name
Position
City
Country
Telephone
(Please include
country code)
Email Address
Referee 2
Salutation/
Title
Mr Mrs Ms
Full Name
(First, Middle,
Last)
Company/
Institution
Name
Position
City
Country
Telephone
(Please include
country code)
Email Address
Referee 3 (Optional)
Salutation/
Mr Mrs Ms
Title
Full Name
(First, Middle,
Last)
Page 8 of 11
SGPP-Indonesia Application Form
Company/
Institution
Name
Position
City
Country
Telephone
(Please include
country code)
Email Address
ENGLISH PROFICIENCY
The programs at SGPP Indonesia are taught entirely in English at native-speaker proficiency. Candidates who are not native speakers and do not hold a Bachelor's
or Master's level degree from an institution whose medium of instruction is
English, must submit to a language test organized by SGPP Indonesia .
English Proficiency Information
Are you a Native Speaker? YES NO
Have you ever participated in any of these English Proficiency tests below? YES
NO
If YES please fill in the form below
TOEFL
IELTS
Date Taken
Date Taken
(MM/YY)
(MM/YY)
Score
Score
Did your Bachelor or Master Degree come from an institution whose language of in struction is English?
YES NO
If NO, please agree to the statement below
I hereby agree to submit to a language test organized by SGPP Indonesia
by the British Council in Jakarta and will attend a three-week English Crash
Course before the start of the new academic year.
PERSONAL STATEMENT
Describe how your personal, professional and academic backgrounds have influenced your decision to pursue a career in the field of public affairs. How and why will studying at SGPP Indonesia
assist
you
in
achieving
your
professional
goals?
Please be specific and limit your response to no more than 1,000 words.
Page 9 of 11
SGPP-Indonesia Application Form
FINANCIAL INFORMATION
How do you plan to finance your studies at SGPP Indonesia?
Personal
By Family
By Company/ Institution
Company/ Institution Name
Address
Telephone
Contact Details
Person In
Charge
Email
I would like to apply for SGPP Scholarship
I have obtained a scholarship from
PAYMENT OF FEES
To complete your application, you will need to pay the application fee of 50
USD
Payment should be made via transfer to
Beneficiary Bank: Bank Central Asia (BCA)
Account No: 4583702612 (USD)
Beneficiary name: Yay. Indonesia Cerdas Unggul
Swift Code: CENAIDJA
Bank Address:
Jakarta Stock Exchange Tower 2
Jl. Jenderal Sudirman Kav. 52-53
Jakarta 12190 - INDONESIA
Please quote: your name – Application Fee
Important: Please attach a copy of the transfer proof when submitting your application
form.
Billing Information
Please complete this form below if your billing address is different from your mailing
address
Address
City
Page 10 of 11
SGPP-Indonesia Application Form
State/ County
Postal/ Zip
Code
Country
Email Address
REQUIRED DOCUMENTS
These following documents are required to complete your application:
a. Two academic and two professional references (please use the separate
forms provided)
b. A personal statement (submitted in the application form) in English
c. A current curriculum vitae in English
d. All official transcripts of your years spent in higher education. Transcripts
in languages other than English must be officially translated into English
e. Proof of English language proficiency (TOEFL 550 minimum)
Page 11 of 11
Please return this application form and required documents to:
By Email
To:
admissions@sgpp.ac.id
By Post (hard copy)
To:
School of Government and Public Policy (SGPP-Indonesia)
Jalan Anyar, Citeureup
Sentul – Bogor 16810
Indonesia
Should you need more information or assistance in completing the application form,
please contact our admission officer via email at admissions@sgpp.ac.id or telephone
at +62 21 2932 5345 (Monday – Friday, 9 AM – 15.30 PM)
Page 1 of 11
SGPP-Indonesia Application Form
PERSONAL INFORMATION
Salutation/
Title
(Please choose
one)
Mr Mrs Ms
Full Name
(First, Middle,
Last)
Gender
(Please choose
one)
Male Female n/a
Date of Birth
(DD/MM/YY)
City of Birth
Country of
Birth
Nationality 1
Nationality 2
(if any)
CONTACT INFORMATION
Primary Email
Address
Other Email
Address (if any)
Permanent Address and Contact
Address
City
State/ County
Postal/ Zip
Code
Country
Telephone
(Please include
country code)
Fax (Please
include country
code)
Page 2 of 11
SGPP-Indonesia Application Form
Mobile/ Cell
Phone
Mailing Address
Is the Mailing Address the same as your permanent address? YES NO
If NO, please complete the form bellow
Address
City
State/ County
Postal/ Zip
Code
Country
Telephone
(Please include
country code)
Fax (Please
include country
code)
Third Party Access
Would you like to allow third party access to your admission process? YES NO
If YES, please complete the form below
Name
Relationship
to Applicant
ACADEMIC QUALIFICATIONS
Post secondary/ Graduate/ Undergraduate Education Information
Institution 1
Degree/ Title
Majoring in
Date of
Graduation
(MM/YY)
Start Date
(MM/YY)
Distinction
(if any)
Page 3 of 11
SGPP-Indonesia Application Form
Status
HELD PENDING
Name of
Institution
Web Address
of the
Institution (if
any)
City
Country
Institution 2
Did you graduate from a second institution or take a second course/ degree in the same
institution?
YES NO
If YES, please complete the form below
Degree/ Title
Majoring in
Date of
Graduation
(MM/YY)
Start Date
(MM/YY)
Distinction
(if any)
Status
HELD PENDING
Name of
Institution
Web Address
of the
Institution (if
any)
City
Country
Institution 3
Did you graduate from a third institution or take a second course/ degree in the same
institution?
YES NO
If YES, please complete the form below
Degree/ Title
Page 4 of 11
SGPP-Indonesia Application Form
Majoring in
Date of
Graduation
(MM/YY)
Start Date
(MM/YY)
Distinction
(if any)
Status
HELD PENDING
Name of
Institution
Web Address
of the
Institution (if
any)
City
Country
ACADEMIC REFERENCE
Your application must be submitted with a minimum 2 academic references. Please
complete the form below for the referees details. SGPP Indonesia will send an email to
each referee to confirm their references.
Referee 1
Salutation/
Title
Mr Mrs Ms
Full Name
(First, Middle,
Last)
Company/
Institution
Name
Position
City
Country
Telephone
(Please include
country code)
Email Address
Referee 2
Page 5 of 11
SGPP-Indonesia Application Form
Salutation/
Title
Mr Mrs Ms
Full Name
(First, Middle,
Last)
Company/
Institution
Name
Position
City
Country
Telephone
(Please include
country code)
Email Address
Referee 3 (Optional)
Salutation/
Mr Mrs Ms
Title
Full Name
(First, Middle,
Last)
Company/
Institution
Name
Position
City
Country
Telephone
(Please include
country code)
Email Address
PROFESSIONAL EXPERIENCE
As the programs at SGPP Indonesia are all designed for young, more or less
experienced professionals, previous work experience is an additional important
requirement for admission to SGPP Indonesia. Students are expected to have between
2 and 10 years of professional experience at the time of application.
Professional Experience 1
Job Title
Page 6 of 11
SGPP-Indonesia Application Form
Company
Name
Start Date
(MM/YY)
End Date
(MM/YY)
Country
Sector of
Activity
Job
Description
Professional Experience 2 (if any)
Job Title
Company
Name
Start Date
(MM/YY)
End Date
(MM/YY)
Country
Sector of
Activity
Job
Description
Professional Experience 3 (if any)
Job Title
Company
Name
Start Date
(MM/YY)
End Date
(MM/YY)
Country
Sector of
Activity
Job
Description
PROFESSIONAL REFERENCE
Your application must be submitted with a minimum 2 professional references. Please
complete the form below for the referees details. SGPP Indonesia will send an email to
each referee to confirm their references.
Page 7 of 11
SGPP-Indonesia Application Form
Referee 1
Salutation/
Title
Mr Mrs Ms
Full Name
(First, Middle,
Last)
Company/
Institution
Name
Position
City
Country
Telephone
(Please include
country code)
Email Address
Referee 2
Salutation/
Title
Mr Mrs Ms
Full Name
(First, Middle,
Last)
Company/
Institution
Name
Position
City
Country
Telephone
(Please include
country code)
Email Address
Referee 3 (Optional)
Salutation/
Mr Mrs Ms
Title
Full Name
(First, Middle,
Last)
Page 8 of 11
SGPP-Indonesia Application Form
Company/
Institution
Name
Position
City
Country
Telephone
(Please include
country code)
Email Address
ENGLISH PROFICIENCY
The programs at SGPP Indonesia are taught entirely in English at native-speaker proficiency. Candidates who are not native speakers and do not hold a Bachelor's
or Master's level degree from an institution whose medium of instruction is
English, must submit to a language test organized by SGPP Indonesia .
English Proficiency Information
Are you a Native Speaker? YES NO
Have you ever participated in any of these English Proficiency tests below? YES
NO
If YES please fill in the form below
TOEFL
IELTS
Date Taken
Date Taken
(MM/YY)
(MM/YY)
Score
Score
Did your Bachelor or Master Degree come from an institution whose language of in struction is English?
YES NO
If NO, please agree to the statement below
I hereby agree to submit to a language test organized by SGPP Indonesia
by the British Council in Jakarta and will attend a three-week English Crash
Course before the start of the new academic year.
PERSONAL STATEMENT
Describe how your personal, professional and academic backgrounds have influenced your decision to pursue a career in the field of public affairs. How and why will studying at SGPP Indonesia
assist
you
in
achieving
your
professional
goals?
Please be specific and limit your response to no more than 1,000 words.
Page 9 of 11
SGPP-Indonesia Application Form
FINANCIAL INFORMATION
How do you plan to finance your studies at SGPP Indonesia?
Personal
By Family
By Company/ Institution
Company/ Institution Name
Address
Telephone
Contact Details
Person In
Charge
I would like to apply for SGPP Scholarship
I have obtained a scholarship from
PAYMENT OF FEES
To complete your application, you will need to pay the application fee of 50
USD
Payment should be made via transfer to
Beneficiary Bank: Bank Central Asia (BCA)
Account No: 4583702612 (USD)
Beneficiary name: Yay. Indonesia Cerdas Unggul
Swift Code: CENAIDJA
Bank Address:
Jakarta Stock Exchange Tower 2
Jl. Jenderal Sudirman Kav. 52-53
Jakarta 12190 - INDONESIA
Please quote: your name – Application Fee
Important: Please attach a copy of the transfer proof when submitting your application
form.
Billing Information
Please complete this form below if your billing address is different from your mailing
address
Address
City
Page 10 of 11
SGPP-Indonesia Application Form
State/ County
Postal/ Zip
Code
Country
Email Address
REQUIRED DOCUMENTS
These following documents are required to complete your application:
a. Two academic and two professional references (please use the separate
forms provided)
b. A personal statement (submitted in the application form) in English
c. A current curriculum vitae in English
d. All official transcripts of your years spent in higher education. Transcripts
in languages other than English must be officially translated into English
e. Proof of English language proficiency (TOEFL 550 minimum)
Page 11 of 11