2013fulbrightma,phd&ddr application formref.letter

7/30/2019 2013fulbrightma,Phd&Ddr Application Formref.letter

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FULBRIGHT SCHOLARSHIPPROGRAMS PRELIMINARY

APPLICATION FORM (PLEASE TYPEOR WRITE IN BLOCKLETTERS)

Affix your recentself

3 x 4 cmsphotograph in this

box.

Personal Information

Name:

Citizenship:

Placeanddateofbirth:

MailingAddress:

((Home)/Cell-phone:

((Office): Fax: Email:

Proposedfieldofstudy:

Program you are applying forPlease check appropriate box.

M.A. PROGRAMS

oFULBRIGHT MASTERS DEGREE PROGRAM oFULBRIGHT-FREEPORT MASTERS DEGREEPROGRAM

oFULBRIGHT MASTER OF SCIENCE & TECHNOLOGYINITIATIVE DEGREE PROGRAM (incl. USAID fundedFulbright Agricultural Program)

PH.D. PROGRAMS


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oFULBRIGHT PRESIDENTIAL SCHOLARSHIP PROGRAM (PH.D) (incl. USAID funded Fulbright AgriculturalProgram)

RESEARCH PROGRAMS

oFULBRIGHT DOCTORAL DISSERTATION RESEARCH AWARD PROGRAM. (Please choose one. Status

of your doctoral studies: Have completed all coursework; Havecompleted doctoral comprehensive exam prior to writing dissertation; Have outlineddissertation proposal; Have had dissertation adviser; Have contacted American university for potential adviser.)

OTHER PROGRAMS

oFULBRIGHT FOREIGN LANGUAGE (BAHASA INDONESIA) TEACHING ASSISTANT (FLTA) PROGRAM

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FULBRIGHT PRELIMINARY APPLICATION FORM

Academic HistoryUniversity/Institute Attended after High SchoolYears Attended Degree Obtained/Expected GPA/IPK

From To (incl. Field of Study)

Scholastic Distinctions/Honors you have received

Year Distinction/Honors

Standardized Test Scores (Please attach a photocopy of each test. Test results should not be older than 2 years)

Test Score Date

TOEFL: oInternational oInstitutional (All

Degree student candidates must take the Graduate Record Examination (GRE for all fields except Law andBusiness) or Graduate Management Admission Test (GMAT for business administration, finance, accounting) ifthey are selected. It is recommended that applicants begin to familiarize themselves with the above test.

Professional History*List your work experience since university graduation. Start with the most current one.Dates (ToFrom) Position Name of Institution/Company

Responsibility

(indicate month)

Social and Community Involvement*List professional, societal, fraternities or other organizations in which you now hold membership or in which you have beenactive in the past. (Indicate if you have held an elective office):

Year Position/Organization Responsibility

Research Projects Completed*

Project name Position in the project Sponsored by Date

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Articles/Books/Unpublished Papers/Thesis/Dissertation*

Title of publication Subject Type** Date

If you have ever traveled or lived outside Indonesia, please specify dates, countries andpurpose*

Dates Country Purpose

Please indicate if you have previously applied for a U.S. visa and the status of thatapplication

Dates Type of Visa Applied for Status of that Application

Study Objective (for Masters applicants only)This section is very IMPORTANT: As part of the evaluation of your application, you are required to attach a onepage (please do not exceed the 1 page limit) of a clear and detailed description of your study objectives. Giveyour reason for wanting to pursue them in the U.S. Describe the kind of program you expect to undertake, and explain howyour proposed field of study fits in with your educational background, your future objectives, and your future involvement incommunity development.

Study Objective and Research Proposal(for Doctoral/Ph.D and Doctoral Dissertation Research applicants only)This section is very IMPORTANT: As part of the evaluation of your application, you are required to attach a onepage (please do not exceed the 1 page limit) of a clear and detailed description of your study objectives. Giveyour reason for wanting to pursue them in the U.S. Describe the kind of program you expect to undertake, and explain howyour proposed field of study fits in with your educational background, your future objectives, and your future involvement incommunity development. In addition to the Study Objective, please add three-five page Research Proposal or ProposedActivity. (See below)

Statement of Proposed Activity

Project title:

This section is very IMPORTANT. Please write, between three to five pages, a clear and detaileddescription of your proposed activity including the following items: (1) Background: When possible, place theproject in academic or professional context by referring to the major work by others on the topic. In some cases this canbe aided by use of a select bibliography. (2) Objective: Define clearly the aims of the project. (3) Methodology:Describe the project and explain the approach andmethods you will follow. (4) Significance: Explain the significance of the project for the field, your own professional

development, and home country. (5) OtherS: (a) Indicate why residence in the United States is necessary foraccomplishment of the project. (b) Explain how your project can be completed within the time period requested.

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OBJECTIVES (for FLTA applicant only)Write a clear and detailed description of your objectives. Give reasons for wanting to participate in the program. Explainhow the FLTA Program fits with your previous education/training and your future objectives. Describe your future plans.THIS STATEMENT IS AN IMPORTANT PART OF YOUR APPLICATION.

When selected, are you willing to perform actual classroom teaching duties? oYes oNoORDo you prefer to have primarily an assistant role (e.g. language lab supervision,

tutoring, animating conversation group, etc.)? oYes oNoBoth options are acceptable to you: oYes

How do you learn about the Fulbright

oNewspaper ads oFriend oWebsite oOther:

If you are currently applying for other scholarship programs, please specify program

and status of your application

Name of Program Type of Program Applied Status of Application

DeclarationI hereby certify that the information I have provided on this application form and in any attached materials is accurateand true to the best of my knowledge and belief, and I agree to notify AMINEF of any change in the aboveinformation or of any further information that might effect my eligibility for consideration as a prospectiverecipient of the Fulbright Scholarship award.I understand that by completing this application form there is no assurance that I will be awarded a grant.I understand that grant funds are not sufficient to cover travel or support for my family and I will makenecessary arrangements for the living expenses in Indonesia while I am away or in the U.S. if they wish tojoin me.

I have no objection to publicity about my selection for a Fulbright Scholarship.

Signature: Date:

Note:*Please attach additional pages if necessary.

**Articles, books, unpublished paper/ thesis/dissertation

The Fulbright educational exchange and the Hubert H. Humphrey program have been active in Indonesia since1952 and 1979 respectively, with hundreds of notables from Indonesias academic community and keyfigures from the governmental, private and cultural sectors having traveled and studied in the United States.

FULBRIGHT INDONESIA, The American-Indonesian Exchange Foundation (AMINEF) was established in 1987to bring a higher level of cooperation and local involvement to the Fulbright Program. AMINEF runs an open,merit-based competition for Fulbright grants. Applications are reviewed by AMINEF selection team. Thoseapplicants who meet the minimum standards of the program are then interviewed by a binational selectioncommittee that includes experts from their fields. The recommendations of the selection committee arereviewed by AMINEF Board of Management. That list is then sent to the J. William Fulbright Foreign ScholarshipsBoard in Washington for final approval.

THIS FORM IS TO BE FILLED OUT COMPLETELY AND

ACCURATELY. WE REGRET INCOMPLETE APPLICATION

WILL NOT BE CONSIDERED. Page 4 of 4


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FULBRIGHT PROGRAMAPPLICATION FOR STUDY IN THE UNITED STATES

FOR A FELLOWSHIP, SCHOLARSHIP, ASSISTANTSHIP OR OTHER EDUCATIONALGRANT

C O NFIDENT I A L LETTER O F REFERENCE

This letter of reference must be written by a teacher under whom the applicant has studied or pursued research in the proposed field of study orsomeone who has supervised the applicant in work related to the proposed field of study. This letter must be typewritten and in English. If not in Englithen an accurate translation must be attached.

NAME OF APPLICANT: COUNTRY:

NAME OF REFEREE:

TITLE

INSTITUTION OR BUSINESS

1. HOW LONG HAVE YOU KNOWN THE APPLICANT?

2. IN WHAT CAPACITY HAVE YOU KNOWN THE APPLICANT? (mark one of the boxes below)

Teacher or Professor Employer or Job Supervisor Research Adviser Other (Please specify)

3. PLEASE PROVIDE A CANDID EVALUATION OF THE APPLICANTS PAST PERFORMANCE AND ABILITY TO PURSUE ANDSUCCESSFULLY COMPLETE A PROGRAM OF STUDY IN THE PROPOSED FIELD. Your statement will be given considerable importance bythe universities reviewing this students application and should, therefore, be as complete and detailed as possible. Your comments should becontinued on the following page if more space is required.

Confidential Letter of Reference Page


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4. IN THIS RATING CHART, PLEASE EVALUATE THE APPLICANT IN COMPARISON WITH OTHER STUDENTS WHOM YOU HAVEKNOWN DURING YOUR POFESSIONAL CAREER.

Excellent Very Good Average Below Average

Intellectual Ability

Knowledge of Field

Work Habits

Motivation to Pursue Graduate Study

Seriousness of Purpose

Potential For Significant Future Contribution in Field

Resourcefulness and Initiative

Emotional Maturity

Adaptability to New Situations

Leadership Qualities

Teaching Potential

NAME (print):

SIGNATURE: DATE:

PLEASE RETURN DIRECTLY TO THE SELECTION COMMITTEE IN THE APPLICANTS COUNTRY OR TO THE CULTURAL

AFFAIRS OFFICER OF THE U.S. DIPLOMATIC MISSION IN THE APPLICANTS COUNTRY. UNDER NO CIRCUMSTANCES

SHOULD THE COMPLETED FORM BE RETURNED TO THE APPLICANT.

NOTE: IIE cannot guarantee this letters confidentiality once it becomes part of a universitys records.

Confidential Letter Reference Pag

2013fulbrightma,phd&ddr application formref.letter

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