OTS Indonesia Application Form 2018 2019
www.nesoindonesia.or.id
ots@nesoindonesia.or.id
Jl. H. R . Rasuna Said Kav S-3
Jakarta 12950 – Indonesia
T. (+62) 21 5248 267
Orange Tulip Scholarship (OTS) Indonesia
Academic year 2018-2019
Application Form
(save with this format: Application Form_targeted university_your name)
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.
☐ Male
☐ Female
Click here to enter text.
Click here to enter text.
2. 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.
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 2018-2019 Application Form
© 19/07/2017
www.nesoindonesia.or.id
ots@nesoindonesia.or.id
Jl. H. R . Rasuna Said Kav S-3
Jakarta 12950 – Indonesia
T. (+62) 21 5248 267
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
(Expected) month &
year of graduation
(mm/yyyy)
☐ High school
☐ Bachelor
Click here to enter text.
☐ Master
☐ PhD
Click here to enter text.
GPA
out of
English exam score &
month + year taken
☐ IELTS
(month+year):
Click here to enter
text.
GRE test result
Click here to enter text.
Month & year taken: Click here to enter
text.
Click here to enter text.
Month & year taken: Click here to enter
text.
(if applicable)
GMAT test result
(if 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 2018-2019 Application Form
© 19/07/2017
www.nesoindonesia.or.id
ots@nesoindonesia.or.id
Jl. H. R . Rasuna Said Kav S-3
Jakarta 12950 – Indonesia
T. (+62) 21 5248 267
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 2018 (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 2018-2019 Application Form
© 19/07/2017
ots@nesoindonesia.or.id
Jl. H. R . Rasuna Said Kav S-3
Jakarta 12950 – Indonesia
T. (+62) 21 5248 267
Orange Tulip Scholarship (OTS) Indonesia
Academic year 2018-2019
Application Form
(save with this format: Application Form_targeted university_your name)
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.
☐ Male
☐ Female
Click here to enter text.
Click here to enter text.
2. 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.
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 2018-2019 Application Form
© 19/07/2017
www.nesoindonesia.or.id
ots@nesoindonesia.or.id
Jl. H. R . Rasuna Said Kav S-3
Jakarta 12950 – Indonesia
T. (+62) 21 5248 267
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
(Expected) month &
year of graduation
(mm/yyyy)
☐ High school
☐ Bachelor
Click here to enter text.
☐ Master
☐ PhD
Click here to enter text.
GPA
out of
English exam score &
month + year taken
☐ IELTS
(month+year):
Click here to enter
text.
GRE test result
Click here to enter text.
Month & year taken: Click here to enter
text.
Click here to enter text.
Month & year taken: Click here to enter
text.
(if applicable)
GMAT test result
(if 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 2018-2019 Application Form
© 19/07/2017
www.nesoindonesia.or.id
ots@nesoindonesia.or.id
Jl. H. R . Rasuna Said Kav S-3
Jakarta 12950 – Indonesia
T. (+62) 21 5248 267
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 2018 (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 2018-2019 Application Form
© 19/07/2017