No.40/8/2009-EO(F)Government of India

Ministry of Personnel, P.G. and PensionsDepartment of Personnel & Training

,North Block, New Delhi-IDated the 4th September 2009

Subject :KDI School - Colombo Plan- One Year Master's Degree Programme in Public Policyscheduled to commence from January 2010 at KDI School of Public Policy and Management,Republic of Korea.

The undersigned is directed to state that the Colombo Plan Secretariat has invited applicationsfor the Master's Degree Programme in Public Policy. The Programme is being jointly sponsored by theColombo Plan Secretariat and the KDI School of Public Policy and Management, Seoul, Korea. TheScholarships will be offered to CPS member countries. The programme is scheduled to commence inJanuary 2010 at the KDI School of Public Policy and Management, Republic of Korea. The details ofthe programme and the application form may be drawn from Ministry of Personnel, Public Grievancesand Pensions website (persmin.nic.in).

2. The MPP Programme aims to educate leaders with a global perspective and an in-depth expertisein public policy-related issues. The curriculum emphasizes both theoretical and applied perspectives.The course concentration areas are:

• Trade and Industrial Policy;• Public Finance and Local Administration;• Human Resources and Social Policy;• Transition and Development Studies and• International relations and Political Economy

3. The candidate should have a minimum of 5 years experience in the public sector and completeda bachelor's degree or its equivalent. The candidates should have proficiency in English by submittingTOEFL(min. 570) or IELTS (min. 6.0) scores with the application form. However, those who havepursued their first degree at an English medium University are exempted from this requirement.

4. The Scholarship award covers a Return economy air fare from the closest international airport toSeoul, Korea; Admission costs; Accommodation; Full tuition; living stipend of KRW640,000 and bookallowance ofUS$300 per student per month.

5. It is requested that the nomination of the suitable candidates may please be forwarded to thisDepartment in accordance with the eligibility criteria and the terms and conditions of the Colombo Plan'sCircular dated 261h August 2009. The Ministry/ State Governments may sponsor the names of onlyGovernment/ Public Sector Undertaking functionary.

6. The nomination details should be submitted in the Colombo Plan Secretariat's prescribedproformas duly authenticated by the Department concerned alongwith all the requisite enclosures.

7. The applications should reach this Department through proper channel not later than Slh

November 2009. Nominations received after the prescribed date will not be considered. The circularinviting applications for training courses is available on this Department's website persmin.nic.in

~hi)Director

I. All Ministries/ Departments, Government ofIndia.2. All State Governments/ Union Territories.[~ith the request to circulate it amongst the related organizations]

\vJ. Director (Technical), NIC with the request to post the circular along with the Colombo Plan's circularand the enclosed application Proformas on the Department's website

.~ THE COLOMBO PLAN~ for Co-opel'tlli.e Economie tuUl Social Derelopment ,,. Asia tuUl the Pacijk

26 August 2009

Ms. Aruna PrabhaUnder SecretaryDepartment of Economic AffairsMiniStry of FinanceRoom No 57, North BlockNew Delhi 110001India

Ref:CP-KRjLT/09/1/(1. 6)

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91:::5

Fax: 9111 2309 2594 9f ~ \ ~

KDI SCHOOL - COLOMBO PLANLONG TERM SCHOLARSHIP PROGRAM

2010 L 2011

The Colombo plan Secretariat invites member countries to nominatecandidates for a one year Master Degree's Program in Public Policy which isscheduled to commence in January 2010, at KDI School of Public Policy andManagement Republic of Korea.

2. This program is jointly organized by The Colombo Plan (epS) and KDI School.For academic year 2010 I 2011, seven (7) places have been offered to the CPSmember countries. Both the CPS and KDI School will bear the following costs:

return ait ticket on economy dass, for student only;

admission process fees;• tuition, housing and livIng stipends; and• book allowance of US$300 per student per month.

3. We attach herewith a copy of project notification containing details of theprogram, rules and requirements of the program, Candidates are advised to read itcarefully so as to avoid any misunderstandings regarding procedures of application.In additionJ candidates are required to visit KDI's website - www.kdischool.ac.krlfor further information and necessary actions to be taken.

~

use. ~~

P.G.Box; 596, 13th FJI)()r, BaI1k of Ceylon MercbaIlt Tower,28, St. Michael'!; Road, Colombo 03, Sri Lanka. -rei; (94-11) 2381831 (AutO), 2564.1.48- F,,"~: (94-1 I) 256453L

e-mail: info@colombo.pla.ll.org Website: www.colombo-plllll.org

4. Please be .informed that application forms, which is hereby attached shouldreach The Colombo Plan Secretariat's office no later than 1S November 2009,The applications shoUld contain all supporting documents including IEl TS/TOEFLscore sheets, academic transcript, etc. All applicants shOUld not already haveMaster's degree in any field and currently not pursuing Master's degree programmein any institutions of higher leaming.

5. Details of this program and the application form can be obtained from ourwebsite - www.colomlJQ-pJan.orql. Application fonns must be endorsed by andsubmitted through the Colombo Plan National Focal Points. We highly regret thatany late, Incomplete and submission without endorsement from the National FocalPoint will be disqualified.

Mo Khu Idi HarunDirector - Programme for PUblic Admlnistr:atlon (PPA)and Environment

cc: H.E. Mr. Alok Prasad, High Commissioner, High Commission of India, 36-38 GalleRoad, Colombo 3, fax: 2446403

Master of Public Policy (MPP)

2010/2011

The KDI School of Public Policy and ManagementSeoul, Korea

Thl? Colombo Plan for Cooperative Economic and Social Development in Asia and the Pacific isa unique int2r-govemmental organization providing development assistance under the"Planning for Prosperitylt motto and the concept of self-help and mutual help wheremember countnes provide assistance to one another in socia-economic development.

The Colombo Plan was conceived at the Commonwealth Conference on Foreign Affairs held inColombo, Ceylon (now Sri Lanka) In January 1950 and was established on 1 July 1951 as acoo~erative venture for economic and sodal advancement of the people of South andSoutheast Asia. It has grown from the founding group of seven Commonwealth nations -Australia, Britain, canada, ceylon, India, New Zealand and Pakistan, to 25, including non-Commonwealth and countries belonging to the Association of South-East Asian Nations(ASEAN) and South Asian Associatior.l for Regional Cooperation (SAARC). Current ColomboPlan member countries are Afghanistan, Australia, Bangladesh, Bhutan, Fiji, India, indonesia,Iran, Japan, Republic of Korea, Lao PDR, Malaysia, Maldives, Mongolia, Myanmar, Nepal, NewZealand, Pakistan, Papua New Guinea, Philippine~, Singapore, Sri Lanka, Thailand, UnitedStates of America and Vietnam.

In December 1977 the Colombo Plan for Cooperative Economic Development in South andSoutheast Asia was changed to The Colombo Plan for Co-operative Economic andSocial Development in Asia and the Pacific, to reflect. the expanded geographicalcomposition of its enhanced membership and the scope of its actiVities. The primary focus ofall Colombo Plan activities is human resources development in the Asia-PacIfic region.

Over the years, the programme content of the Colombo Plan has been adjusted to respond tothe needs of member countries in a fast changing economic environment. In the early years,the training progr~mmes were mare of a long-term nature whilst the current programmes areestablished to prOVide advance skills and experience sharing, aimed at arriving at the bestpl'dctices in different fields of economic and social activities for effective policy making andgovernance.

A significant characteristic of the Colombo Plan is that the administrative costE of the Counciland the Secretariat are borne equally by all member countries and all member countries havean equal status in Colombo Pl~n's functions and activities. However, programme activities arefunded by voluntary contributions by member countries as development partners. In addition,non-member countries, other international and regional organisations and other donoragencies are also sourced for funding.

In 1995, Colombo Plan revitalized its programmes to emphasize on short-term training .courses in priority areas and promoting South-South cooperation, The current programmes ofthe Colombo Plan are in the areas of Public Administration and Environment including post-graduate long-term scholarships, Private Sector Development and Drug Demand Prev~ntiQn inmember countries. In this regard, Colombo Plan has established three programmes forcapacity bUilding, namely, Drug Advisory Programme, Programme for PubliC Administration &Environment and Programme for Private Sector Development.

Programme for Public Administration c;!nd Environment (PPA) was established In 1995,following the reviGlization of the Colombo Plan's structuri:! and areas of focus. The primaryobjective of this program is to develop human capital in public sector of the developingmember countries (DMCs)/ through long term and short term training programmes inprioritIzed areas such as project planning, IT management, economic planning, crisismanagement! education, public governance, gene based techniques and environment:t! Issuessuch as air pollution management, Integrated environmental planning.

The PPA conducts training programmes for middle and senior level government officials ofdeveloping and under developed CPS member countries, through joint collaboration withpartners like Malaysian Technical Cooperation Programme (MTCP), Thailand InternationalCooperation Agency (11CA)/ Indian Millennium Fund (IMF), Pakistan Technica! Cooperationand Technical Assistance Directorate of Singapore. The PPA has estoblished goodpartnerships with centres of excellence in its member countries as well as with in~r·governmental organisations to deliver training programmes in critical issues of development.From 1995 up to date, 1581 government officials from CPS member countries havepartidpated in PPA's training programmes.

The Progrctmme for Private Sector Development (PPSD), established in 1995 provides short-term training programmes and work5hops for the development of the private sector. Thefocus of PPSD is on capacity building of smi:lll and medium enterprises (SMEs), which in manyeconomies drive economic growth and create employment opportunities for a large segmentof the labour force. The Programme's scope covers technology transfer, SME development,business management and sharing of best practices, World Trade OrganiZl'tion, productivityand trade issues and industrialization policy. PPSD also plays an imporh'lnt role in promoting abusiness friendly environment through building up of capacity of those relevant governmentofficers who are responSible to put in place supporting insbtutions, laws and policie~a~ wellas regulations, which affect the private sector,

To obtain the best outcomes for these programmes, PPSD collaborates with membergovernments and their centres of excellence to implement the programmes. Our currentpartner agencies are Korea International Cooperation Agency (KOICA), Malaysia ProductiVityCentre (MPC), and CMC Ltd under the Indian Millennium Fund, Asia ProductiVity OrganizationCAPO) and Singapore Cooperation Programme (SCP). Since inception in 1995, Korea has beencontributing to the PPSD programmes. Since then 1272 officials from CPS member countrieshave partiCipated in PPSD's training programmes.

The Long-term Scholarship Programme (LTSP) was a hallmark of the Colombo Plan during itsearly years until 1989. Due to the needs of member countries, it was offered again in 2005 toprovide opportunities for suitable candidates from member countries to pursue their Master .Degrees In prestigious universities In Korea, Malaysia, Thailand and Singapore. Since 1995until current date! 89 scholars from 18 CPS member countries have benefited from thisprogramme. The Colombo Plan annually offers 42 scholarships to its member countries.

The Colombo Plan Drug AdvIsory Prog~mme, launched in 1973, was the first Asi;:l-Paoficregional programme to address the drug problem. From its inception, DAP has beencontributing to the development of human resources in member countries by enhancing thecapabilities of officials in government and non~govemmental org'.mizations involved in drugdemand and supply reduction,

Responding to the changing needs of member countries, which ~re facing multi-facetedproblems due to illidt drug production, trafficking and abuse, the DAP has embarked onseveral innovative strategies including faith-b~sed approach to drug demand reduction,establishment of outreach and drop in centres and introduction of life skills to youths.

OAP also mobilizes community in its drug demand reduction activities ~s well as provideadvisory services and capacity building to member countries.· In front line countries likeAfghanistan and Pakistan, four (4) Outreach and Drop-In Centers (ODIC) were established in2005 which continue to be supported.by CPDAP. Two (2) other aOles ~re in the Philippines.In the special programme for Afghanistanr in cooperation with the Mini5try of CounterNarcotics and th~ Ministry of Public Health 16 treatment centers and transit shelter- for womenwere set up in June 2007. DAP is operating two (2) Treatment Center-s for women in Kabuland Balkh, Afghanistan. Iii February 2009, DAP est4'lblished I'l training center, Asian Center forCertification and Education of Addiction Professionals (ACCE). ACCE will offer two levels ofcredentials to the addiction professionals in Asia: National Certificdtion EXClrnination forAddiction Counselors levels 1 & 2. ACCE will register the first batch of participants for NCACLevell in July 2009.

The KDI School of PUblic Policy and M~nagement was established in 1997 with the support ofthe Korea Development Institute (KDI), which is Korea's leading economic think-tanl< since1971. The School aims to be i3 world-class institution by offering innovative education~!programmes for future intem~tjon1'l1 leaders of government and business organizations andequip them with the latest knOWledge to meet the challenges of a globalized world.

The KDI School offers in-depth academic programmes that focus on real-world managementand public policy issues and are taught by experienced faculty comprising experts andprofessionals in their own fields. The curriculum is both innovative and comprehensive; it wasdesigned specifically with the needs of midlevel professionals from the public and privatesectors. Classes use various modern technologies to maximize efficiency and learningeffectiveness.

The Colombo Plan began collaboration with The KDI School of Public Polley and Managementin 2006. It symbolises a significant milestone in Republic of Korea's role in Colombo Plan. ThisLong Ter-m Scholarship (LTSP) represents ROK's first assistance programme for post graduatescholars of the Colombo Plan in the field of public polley. Since 2006, fOur batches of 19Colombo Plan's scholars have been trained by The KDI School.

MASTER OF PUBLIC POLICY (MPP)

DESCRIPTION

The one year Master of Public Policy (MPP) program for foreign students is conducted by theKDI School of Public Policy and Management in Korec. The academic year is based on a

trimester system and in prindple; it takes one year to complete the coursework. Studentsneed a minimum of 45 credits to receive a degree. Of the 45 credits, 39 credits must beobtained through coursework in the first year. The remaining 6 credits can be fulfilled bysubmitting a masters thesis (worth 6 credits) before or after returning to one's country ofresidence and/or workplace.

The MPP program aims to @!duc:ateleaders with a global perspective and an in-depth expertisein public policy-related issues. The curriculum emphasizes both theoretical and ('lppljedperspectives. MPP has concentrations as listed below.

rhls concentr('ltion focuses on two of the most important areas of economic policy i.e.Trade Policy and Indl1strial Policy. The curriculum is designed to provide students with anunderstanding of industrial policies. If emphasizes both theoretical ~nd applied perspectives,supplemented by case-studies on microeconomic policy.

The purpose of this concentration is to provide studi:':nts with the understanding in the areasof government budgeting, taxation and public ~dmini5tration, and to educate experts in publiceconomics to develop effective policies.

Extensive analysis of domestic and international c;:Ise studies on human resource and socialpolicy is conducted in this concentration. Specific programs and problems in current socialpolicies will be discussed in class. Students will be eqUipped with prindples and i'lnalyticaltools required for formulating policies.

This concentration covers a wide spectrum of ecnnomic and social development issues,highlighting many things from Korea's transitional development. The concentration 1'11$0analyzes the transition methods of developing countries, including former socialist countries,and trains the students to build and execute applicable economic development strategies forvarious parts of the world.

This concentration provides the skills and conceptual framework needed to understandpolitical and international issues in both domestic and international circles. Core topics includepolitical economy, national identity, Kore~n reunification, democracy/ economic cooperation,conflict and resolution, and international organizations.

Concentrations are determined by the individual student in the third term of his/her study atthe KDI SchOOl.

The Master of Public Policy (MPP) program is conducted on a full - time basis starting inJanuary 2010, and requires one year's coursework. '

All appliCants for the Master of in Public Policy (MPP) program must meet the follm.vingminimum general requirements.

1. Minimum5 years experiencein the public sector.2. Nominated by the Colombo Plan National Focal Point of their respective

Governments3. Completeda bachelor'sdegree or it5 eqUivalent.4. Meet English language requirements.

Applicants must prove proficiency in English by submitting TOEFL (minimum 570) or lELTS(minimum 6.0) scoms with the application form to Colombo Plan. (A copy of EnglishLanguage test results must accompany the Application form). Those who pUr$ued their firstdegree at an English medium University are exempted from this requirement.

The scholarship awards will cover the following:

• A return air ticket on economy class from the closest international airport to SeoutKore(l.

• Admission costs

• Accommodation

• Full tuition

• Living stipend of KRW640,OOO

• Book allowance of US$300 per student per month

Applicants will need to obtain a visa from the Korean Embassy in their countries or otheraccredited countries before their arrival in Korea. Participating Governments are kindlyrequested to bear the cost of visa application for their participants. The Colombo Plan will notprovide visa fees. .

Each member country is requested to nominate through the National Focal Point tvIIocandidates by completing the Application Formr the Medical Certificate and Admission Essay.

Please send the duly completed nomination forms (two sets) to the Colombo Plan Secretariatat the following addresses! by or before 15 November 2009.

Secretary GeneralThe Colombo Plan Secretariat13th Floor, Merchant Tower28r St. Michael's RoadColombo 3Sri Lanka,Tel: + 94 11 2564448Fax: + 94 11 2564531

Any queries can be forwarded to Mr. Mohd Khuzaidi Harun, Director of Public Administrationand Environment at khuzaidi@colombo-plan.org

Please refrain from sending Applici;!tion Forms directly to the KDI Sc.hool.The deadline fOf the nominations will be strictly observed.

Selections for the MPP program will be done jointly by CPS and KDI School. Since we intendto notify the applicants of their acceptance as soon as their applications are processed,sending nominations as early as possible is very much advisable.

Application form need to be filled in and sent to the Colombo Plan Secre~ri~t. Theonline application can be found on the Colombo Plan website \WIW.colQmbo-olan.org

Applicant should enclose a certified copy of bachelor's degree dipioma and bachelorstranscripts in English with the application. Transcripts must be certified by the issuingbody.

Please send a copy of the O(iginal score sheet (TOEFL - minimum 570 or IELTS -minimum 6.0) with the application. (Applicantsr who followed the first degrees inEnglish mediurn, are required to prove their English profidency by submitting copies oftheir degree certificates. No consideration will be given if the required documents arenot attached.)

Include two letters of recommendations. Letters should preferaQly be from University'ProfesSOrs or from the Employer. Please inform the recommenders that they shouldput the recommendation letters into sealed envelopes and signed across the flap.Open and unsealed recommendations are not acceptable.

The admi5sion essay is an important piece of the ~pplication. It should be carefullycrafted to include your personal and career go~lsf desir-e to do graduate studies! andability and commitment to attend the year long intensive MPP program. It should alsoindicate your purpose and reasons for applying for this course.

Applicant must indude a Certificate of Employment from the Employer with theapplication.

Applicant must be in good health to study in abroad for one year. Pregnancy duringthe period of application and selection will disqualify the applicant.

I' IMPORTANT INSTRUCTIONS: II

Each question must be answered clearl)' and completely.• Duly completed Application Forms should be forwarded to the I 1

Colom ho Plan Secretariat through the Colombo Plan ~ational Focal I !

Point in such country. I• Incomplete and/or unendorsed applications will not be considered. ,• Academic: transcript & the rELTSrrOFEL result she~ts must be Ii \ :~

attached ._~-R-S-O-N-A-L-I-.N-F-O-RMA--T-I-O-N-----=-~~~~~~~~~-_-_-_- 1

I L Name in Full:1

Photo3cm x4cm

••(Sample) SMITIf. John Andrew. . -----

_3_, D_a_t_e_Df_B_irth_: (y_y__Y_Y_fffi_m1_d_c1)__ l_4:.Coumry of Citizenship:

~5_, _Pa_s_sp_o_rt.N_D_._: ~I_~.Marital Status: 0 Mar_ri_td__ D_Si_fi_gl_c _

I:mail:Phone No.:

(Country code larca code/phone number)

Mobile f>hone;

Addres~:

Fax No.:AdcJr~s.,:

ComD~_m_,: ~ _

pepartment:Position:

Phone No. (Day): ~P~hQ,,-n_e•••N_o_._(~E_v~en~j~n•...£.)_~ _Emergency Pholle Number (person in Korca preferred);

(country code / area code I phone number)

• Mailine; address the alXleptance Ic:tte:rand udmissions package should be delivered to (Only for accepted applicants)

o Hom~ Addrt:ss .D Work Address.

II. ACADEMIC INFORMA nON (Please list ail advanced institutions attended, with the most recent listedfirst. Write all in[orrniUion in the l:Paces provided bc:low.)

Name of School Dl.l.tes AttendedrH>" •.••••~ M~·,,~

"-

LIyyimm yy1mm I

/ .I-

I yy I mm yylmm

I

/ .1_'-yy Imm yy1mm

f . IJ

I

II-

II

yy I mm yy I mm I-_ ..------'

Ill. WORK EXPERIENCE (Please list the most recent ernploymatl first,) 1I

I!

Name of Compa.ny Dates Employed Name of IDenartment Position

_w

I . ! II-

iI I

yy Iml11 yy Imm I I

iI I -

I I~yy Imm yy1mm

I

I; .

_1-yylmm yy/mm

I - J II-

I iI I

yy/mm yy/mm Ii I

i .-I DaLe: iTOEFL Score: ~

IV. TOEFL, TOEIC, Otber Sc:oresandDlIteofTest(Please enclose n copy of your SCOrereport.) Others (lEL TS, ORB, OMAT, etc.):\ ~L_ D"" ._-~

I V. LIST OF RECOMMEND~RS

r;:-me:I

Organization;

Position;I

[ SieDamre of AppliC:8nt:

'j Name:I OrgEllliwion:

'__ P_O_s_itio_n_: ~_- ---~

The Statement of Purpose should be in English (A4, double-spaced, single-sided) Responses must be writtensolely by the appUcanL without any assistance from olbers. Essays not 100% from the applicRnt will be gro\lndsfor complete dismissal of any scholarship considc:ration. Please refer to the prompts below. Essays should betyped or legibly printed.

Statement of Pur-p(lseN~me in Fu8(1,ast, First Middle):

Couutry of Citizenship:

1. E:tplain YPdr most important lI~('omplishmeot /lod explain wily you think it as sut'it. (Less than 400 words)

2. D~cribe your caJ"eer vision and wby you have cllosen it a$ your vil'ion. (Less than 400words)

J. Describe yOIl!' potential contrihutions to the class if you were to receive admission to the KDI Sehool. (Less than 400 words)

, hereby submit my Smtemenr of Purpose and Ceriify that I have receiv:;d no assistance in writing J:hisessay.Month; Da)' !Year

• To the Applicant:Please complete ONLY the top port.ion of this form. Mail this form with it self-addr~ssed stamp~d envelDp~ \.0 theperson who will write YO\.lr recommendation. Please tell ),our rCC'JJmmendcr t.o enclose ~he form he/she has wnnenon your beh{l.)f,seal ~he envelope, sign across the t1ap, and mail it to you. Enclose the sealed envelope wiIh yourcompleLed applica.tion .

• To tbt RecollnneDder:Thank yO\! for agreeing to write an evaluation 01'1 behalf of the individual named above. We value your frank andrhoughrfuJ assessment of the applicant. After filling Qut the form., please seal and sign the back flap of theenvelope. Atta.ch additional sheet.': ifnecessary.

!I

! 2. What do you consider to be the applicant's strength_$_Or_tll_l_cn_ts_·! ~ __

III 4. How would rOd r-ate tbe applicaDt relative to Dthers in your organi~tioD (school)?

IPlease give us your appraisal of the applicant in termS of th~. qualities listed beloW. Rate the applicant in.comparison with others applying for graduale school whom you have knowr\, or with top performing men andwomen in his or her professional peer group_

Troly Ex~el1ent Very Good Gool::l Below I !ExcepLional Average

No ITop Top Top Middle Lower Infonnation

2% 10% 25% 50% 25%

Leadership Potential IInterpersonal Skills

I Ii

I AnalyLical Ability i IOralCommunication Skills

WrinenCommunication Skills IImagination & CreativitY I

!II

I !I Motivation ji ,

lindependence IFlexibility I i

i

Are yOll confident of the applicant's integrity?DYes I: Unable to judge 0 No

In summary, I (Please check one.):J srrongly recommend 0 recommend 0 reeornmend with mme reservations 0 do not fecomm(:lld(his appliclUlt for the program at the Kl)1 School.

Please complete the following infurnuuion and '.Iuite your preferred llddress [or fecciving corrcspcndence fromthe KDI Schoo!'

I Recommender InformatioD-' -i 1. Na.me:

II 3. Position or Tide:

I\ 5. Phone Number;

I,ll Country codeian:~ codillphone number----

To the Applicaot:Please: c:ompl~te O~L Y the top portion of this form. Mail1hiS fonn with a scl[-~ddressed su.rnped l'nvelope to 1.he

pe~on who will write your recommendation. Ask your recommender to enclose the form he/she has written onyour behalf, seal the envelope, sign ac;ross the flap, and mail it to you. Enclose the scaled envelope with ;:ourcompleted application.

To the Recommender:Thank you for agreeing to write an evaluation on behalf of the individual named above. We value your frank andthoughtful assessment of the applicanT.- After filling out the form, please seal and sign the back n••.p of theenvelope. Attach addiLional shec:1.Sifnecf:ssary.

11. Ho; long have: you klJo~n the appll~aD:and in ~bat capuit)'?i .-.------

I

3. Wb,.t do you eonsider to be tb" .ppllcaot's weaknesseS or developmental needs? i-------------·-----iiIi

I!

-iII 4. How would you rate the applicant rel"tlve to others in your organization (.~cbool)?

IL-.,__ ~ _

Please give I1S your appraisal of the applicant in terms of the qualities listed below. Rate the ~pplicllTlt incomparison with others applying for g~aduate school whom you have known, or with top perfoTl'lling men andwomen in his or her professional peer group.

If you are CUlTently employed and are applying to the KDI SCHOOL with the approval of youremployer, you should have your employer fill out this form. If available, attach an official document,issued by your employer, that verifies your employment status .

• To the Applicant:Please provide the information requested below. Send this form lO your employer early enough for it tobe returned to you in time to submit willi the rest of your appiication.

IName of Applicant (Last, First, Middle)

Position

I hereby request the release of an official verification of my current employment and informationconcerning my employment status at the organization specified below to the KDI School of PublicPolicy and Management.

• To the Person in Charge of Employee TraininglEducation:The above-named person is applying to the KDI School of Public Policy a...'1d Management. Pleasecomplele this form and enclose an official acknowledgement of the applicant's current employmentstatus. Thank. you.

- "

Name of Organization I!

I Name of Organization Head II Organj~tion's Website Address i

-Il\ame of Personnel Department !

,

I Name of Personnel Department Head !

Name of Personnel Dept. Contact Person .~II AddressI

E-m·,

,111

_;~:_I~p_h_on_e. 1 ~ ~__.~-]r-;:m (yyyy/mrn/dd):

I hereby certify lhat the above-mentioned applicant has been recommended by our organization toattend the KDI Sellaol of Public Policy and Management during the period indicated in #2 above.

MEDICAL REPORT ON STUDENT APPLYING FOR ADMISSTON TOFULL TIME COURSE IN MALAYSIA

4. Personal History: Details of important illness, accident or operation should be given togetherwith subsequent treatment partiCulllI should be made concerning any form of tuberculosis, rheumaticfever, cholera, fever, dyspepsia, epikp5i)', diabetes, nervous or mental illness and known allergies.

Present Condition:a. Heightb. Weightc. Physique

VaccinationTuberculin test resultBlood group

Respiratory System:a. Noseb. Chest Expansionc. Complete X - ray Report

of the chestFilm No: Hospital:

PharynxLungs (R& L)

7. Circulatory System:a. Pulseb. Blood Pressurec. Heart

Alimentary System:a. Appetiteb. Bowelsc. Tongued, Liverc. Haemorrho ids

DigestionTeethSpleenRupture

Nervous System:a. Temperamentb. Hearing

ReflexesSight

Reproductive System:a. Varicoseb. Gonorrhoea

Urinary System:a. Specific Gravityb. Sugarc. Albumin

DepositsMiscellaneous

1Z Is the catldidate at present:a. Undergoing a treaOTIC:nIb. Receiving medical attention

Signarure of Physician:Name:Address:

13. Certification from Nominating Agency:I certify that the candidate has been medically examined bye. qualified and registered medical

practitioner.

Signature:Name:Rank! Title:Agency:

NOle: In completing this form, particular artention should be paid to the follmying poin1.S:a.. X-ray of chest to mle out any tuberculosis or chronic pulmonary disease, where the film is

entirely normalb. Kidneys - no evidence of renal lesion ~hould be present:.c. Eyesight - Severe errors ofrefraction should not be passed as these should only give

trouble during the years of training.d. Hearing - deafness should be considered of defmite bar.