OTS Application Form 2017 2018
www.nesoindonesia.or.id
info@nesoindonesia.or.id
Menara Jamsostek 20th Floor
Jalan Gatot Subroto 38
Jakarta 12710 – Indonesia
T. (+62) 21 52902172
Orange Tulip Scholarship (OTS) Indonesia
Academic year 2017-2018
Application Form
1. PERSONAL INFORMATION
Full name
Click here to enter text.
Address
Click here to enter text.
City & postcode
Click here to enter text.
E-mail
Click here to enter text.
Mobile phone & telephone
Click here to enter text.
Birthday (dd/mm/yyyy)
Click here to enter text.
Birthplace
Click here to enter text.
Nationality
Click here to enter text.
2.
☐ Male
☐ Female
Click here to enter text.
Click here to enter text.
STUDY PROGRAMME IN THE NETHERLANDS
☐ I am currently applying to one of the eligible programmes
Study programme: Click here to enter text.
Institution: Click here to enter text.
Current application status
☐ I have been accepted by the eligible Dutch institution in one of the eligible study
programmes
Study programme: Click here to enter text.
Institution: Click here to enter text.
(See list of eligible programmes and participating institutions at www.nesoindonesia.or.id/ots)
☐ No
☐ Yes (please specify below)
Institution
Are you also applying to
other institutions under the
Orange Tulip Scholarship?
Study programme
Click here to enter text.
Click here to enter text.
Click here to enter text.
Click here to enter text.
Click here to enter text.
Click here to enter text.
Click here to enter text.
Click here to enter text.
You can apply to more than one OTS schemes. For each scheme, a separate OTS
application form needs to be submitted.
Orange Tulip Scholarship Indonesia 2016-2017 Application Form
© 30/10/2015
www.nesoindonesia.or.id
info@nesoindonesia.or.id
Menara Jamsostek 20th Floor
Jalan Gatot Subroto 38
Jakarta 12710 – Indonesia
T. (+62) 21 52902172
3. ADDITIONAL OTS INDONESIA SCHEMES
If you would like to be considered for additional schemes, please write the additional scheme(s) that you are interested in.
IMPORTANT: Please regularly check the offered additional schemes and the requirements at
www.nesoindonesia.or.id/ots
☐ Additional scheme 1: Click here to enter text.
☐ Additional scheme 2: Click here to enter text.
☐ Additional scheme 3: Click here to enter text.
4. ACADEMIC BACKGROUND
Name of last/current
education institution
Click here to enter text.
City & country
Click here to enter text.
Study programme
Click here to enter text.
Level of degree (to be)
obtained
☐ High school
(Expected) month & year
of graduation (mm/yyyy)
Click here to enter text.
GPA
☐ Bachelor
Click here to enter text.
☐ Master
☐ PhD
out of
English exam score &
month + year taken
☐ IELTS
(month+year): Click
here to enter text.
GRE test result (if applicable)
Click here to enter text.
Month & year taken: Click here to enter
text.
GMAT test result (if
Click here to enter text.
Month & year taken: Click here to enter
text.
applicable)
☐ iBT (month+year):
Click here to enter
text.
☐ I have not taken an exam yet
5. WORKING EXPERIENCE
Current or last working experience (If applicable). Please include your curriculum vitae on a separate file
Company/ organization: Click here to enter text.
Job position: Click here to enter text.
Short job description (max. 2 lines): Click here to enter text.
Other working experience(s) (max. 2 lines): Click here to enter text.
6. FINANCING YOUR STUDIES
How do you plan to finance your studies at the Dutch higher education institutions (multiple answers possible)?
☐ My own savings
☐ Bank credit/loan
☐ Parents or family
☐ Scholarship(s)
☐ Employer
☐ Other: Click here to enter text.
Orange Tulip Scholarship Indonesia 2016-2017 Application Form
© 30/10/2015
www.nesoindonesia.or.id
info@nesoindonesia.or.id
Menara Jamsostek 20th Floor
Jalan Gatot Subroto 38
Jakarta 12710 – Indonesia
T. (+62) 21 52902172
Please specify other scholarships that you are applying to:
Click here to enter text.
7. CHECK REQUIRED DOCUMENTS
Please check the required documents of each scheme at www.nesoindonesia.or.id/ots
Please send the required documents to Nuffic Neso Indonesia (ONLY softcopy to ots@nesoindonesia.or.id) before 1 April
2017 (unless the institution for which you are applying mentions a different deadline on the Orange Tulip Scholarship
website). Incomplete forms and packages will not be taken into account.
PLEASE NOTE THAT EACH ORANGE TULIP SCHOLARSHIP SPONSOR MAY REQUIRE ADDITIONAL DOCUMENTATION. PLEASE
READ CAREFULLY THE INFORMATION ON THE NUFFIC NESO INDONESIA – ORANGE TULIP SCHOLARSHIP WEBPAGE
All data will be treated strictly confidential by Nuffic Neso Indonesia and the selected Dutch higher education institutions,
solely for the purpose of the Orange Tulip Scholarship Indonesia programme application.
I certify that the information I have provided in this form is true, complete and correct.
Place
: Click here to enter text.
Date
: Click here to enter text.
Name
: Click here to enter text.
Signature
: Click here to enter text.
Orange Tulip Scholarship Indonesia 2016-2017 Application Form
© 30/10/2015
info@nesoindonesia.or.id
Menara Jamsostek 20th Floor
Jalan Gatot Subroto 38
Jakarta 12710 – Indonesia
T. (+62) 21 52902172
Orange Tulip Scholarship (OTS) Indonesia
Academic year 2017-2018
Application Form
1. PERSONAL INFORMATION
Full name
Click here to enter text.
Address
Click here to enter text.
City & postcode
Click here to enter text.
Click here to enter text.
Mobile phone & telephone
Click here to enter text.
Birthday (dd/mm/yyyy)
Click here to enter text.
Birthplace
Click here to enter text.
Nationality
Click here to enter text.
2.
☐ Male
☐ Female
Click here to enter text.
Click here to enter text.
STUDY PROGRAMME IN THE NETHERLANDS
☐ I am currently applying to one of the eligible programmes
Study programme: Click here to enter text.
Institution: Click here to enter text.
Current application status
☐ I have been accepted by the eligible Dutch institution in one of the eligible study
programmes
Study programme: Click here to enter text.
Institution: Click here to enter text.
(See list of eligible programmes and participating institutions at www.nesoindonesia.or.id/ots)
☐ No
☐ Yes (please specify below)
Institution
Are you also applying to
other institutions under the
Orange Tulip Scholarship?
Study programme
Click here to enter text.
Click here to enter text.
Click here to enter text.
Click here to enter text.
Click here to enter text.
Click here to enter text.
Click here to enter text.
Click here to enter text.
You can apply to more than one OTS schemes. For each scheme, a separate OTS
application form needs to be submitted.
Orange Tulip Scholarship Indonesia 2016-2017 Application Form
© 30/10/2015
www.nesoindonesia.or.id
info@nesoindonesia.or.id
Menara Jamsostek 20th Floor
Jalan Gatot Subroto 38
Jakarta 12710 – Indonesia
T. (+62) 21 52902172
3. ADDITIONAL OTS INDONESIA SCHEMES
If you would like to be considered for additional schemes, please write the additional scheme(s) that you are interested in.
IMPORTANT: Please regularly check the offered additional schemes and the requirements at
www.nesoindonesia.or.id/ots
☐ Additional scheme 1: Click here to enter text.
☐ Additional scheme 2: Click here to enter text.
☐ Additional scheme 3: Click here to enter text.
4. ACADEMIC BACKGROUND
Name of last/current
education institution
Click here to enter text.
City & country
Click here to enter text.
Study programme
Click here to enter text.
Level of degree (to be)
obtained
☐ High school
(Expected) month & year
of graduation (mm/yyyy)
Click here to enter text.
GPA
☐ Bachelor
Click here to enter text.
☐ Master
☐ PhD
out of
English exam score &
month + year taken
☐ IELTS
(month+year): Click
here to enter text.
GRE test result (if applicable)
Click here to enter text.
Month & year taken: Click here to enter
text.
GMAT test result (if
Click here to enter text.
Month & year taken: Click here to enter
text.
applicable)
☐ iBT (month+year):
Click here to enter
text.
☐ I have not taken an exam yet
5. WORKING EXPERIENCE
Current or last working experience (If applicable). Please include your curriculum vitae on a separate file
Company/ organization: Click here to enter text.
Job position: Click here to enter text.
Short job description (max. 2 lines): Click here to enter text.
Other working experience(s) (max. 2 lines): Click here to enter text.
6. FINANCING YOUR STUDIES
How do you plan to finance your studies at the Dutch higher education institutions (multiple answers possible)?
☐ My own savings
☐ Bank credit/loan
☐ Parents or family
☐ Scholarship(s)
☐ Employer
☐ Other: Click here to enter text.
Orange Tulip Scholarship Indonesia 2016-2017 Application Form
© 30/10/2015
www.nesoindonesia.or.id
info@nesoindonesia.or.id
Menara Jamsostek 20th Floor
Jalan Gatot Subroto 38
Jakarta 12710 – Indonesia
T. (+62) 21 52902172
Please specify other scholarships that you are applying to:
Click here to enter text.
7. CHECK REQUIRED DOCUMENTS
Please check the required documents of each scheme at www.nesoindonesia.or.id/ots
Please send the required documents to Nuffic Neso Indonesia (ONLY softcopy to ots@nesoindonesia.or.id) before 1 April
2017 (unless the institution for which you are applying mentions a different deadline on the Orange Tulip Scholarship
website). Incomplete forms and packages will not be taken into account.
PLEASE NOTE THAT EACH ORANGE TULIP SCHOLARSHIP SPONSOR MAY REQUIRE ADDITIONAL DOCUMENTATION. PLEASE
READ CAREFULLY THE INFORMATION ON THE NUFFIC NESO INDONESIA – ORANGE TULIP SCHOLARSHIP WEBPAGE
All data will be treated strictly confidential by Nuffic Neso Indonesia and the selected Dutch higher education institutions,
solely for the purpose of the Orange Tulip Scholarship Indonesia programme application.
I certify that the information I have provided in this form is true, complete and correct.
Place
: Click here to enter text.
Date
: Click here to enter text.
Name
: Click here to enter text.
Signature
: Click here to enter text.
Orange Tulip Scholarship Indonesia 2016-2017 Application Form
© 30/10/2015