Name ________________________________ Faculty /University______________________ Semester/Student ID____________________
GOODWILL LEADERSHIP DEVELOPMENT SCHOLARSIP PROGRAM Application 2012-2013
Please, answer every question with capital letters and attach all the information related to the questions
1.
Personal Data
Name Date and place of birth Religion Marital status (single/married) Present address/telephone Home address/telephone School address/telephone Email address Emergency contact Person/address/telephone. Type of accommodation (parents/relatives/dorm/ rented room/other please state)
Hobbies/interests
2.
Family Information
Father
Name: Address: Job: Gross salary (please attach evidence) Level of education
Mother
Brothers/sisters How many? What age? Additional comments
Brothers
Sisters
Name ________________________________ Faculty /University_____________________ Semester/Student ID___________________
3.
Financial Data
How much is your annual tuition fee? Please list what you actually paid in 2011-12
How much is your actual monthly expenses? Please specify.
Housing Food Transport School books/stationary Other Total
_________________
Please list all sources of income you received per month from January to November 2011, from where and how much?
Parents Other family members Scholarship Job Other Total
__________________
How did you cover your school fees and other monthly expenses?
Present paid job and position? How many hours do you work every month? How much do you earn every month? How long have you had this job?
4.
Scholarship
Have you ever received any scholarship award in the past two years? If you have, please list from where, how much, how long.
Name ________________________________ Faculty /University______________________ Semester/Student ID____________________
5.
Academic Information
Elementary school
Comments
Middle School
Comments
High School
Comments
University attending
Faculty
Department
Year of entrance
Year of study/semester in August 2012 - January 2013
Year/month to complete study Grade point Average (GPA or IPK) for past 3 semesters (please attach official transcripts) Have you received any awards from your university If yes, please explain. List completed certified courses, and how long you took each course. (English, computer course, etc) List your academic and non academic achievements
Name ________________________________ Faculty /University______________________ Semester/Student ID____________________
6.
Non-academic experiences
4.1 Please list your organizational experiences and position/s you have held during the past three years.
4.2 Please list your extracurricular and volunteer activities during the past three years.
4.3 Please list your paid job experiences and positions you have held during the past three years.
4.4 To which activity or interest have you made the greatest commitment or contribution? Why? What do you feel you have accomplished?
Name ________________________________ Faculty /University______________________ Semester/Student ID____________________
7.
References
Please list and attach (3) recommendations from the following 3 people. 1. Academic Advisor (PA)
Name: Position: Telephone: Email:
2. Head Department ( Ketua Jurusan )
Name: Position: Telephone: Email:
3. Local Authority (Ketua RT or LURAH)
Name: Position: Telephone: Email:
Check list of Attachments
References---- 1, 2 & 3 (S.7) Answers to Additional Questions (S.8) Profile (S.8) Essay ---- 1, 2 & 3 (S.10)
Students signature: Date:
_____
Name ________________________________ Faculty /University______________________ Semester/Student ID____________________
8.
Additional Questions
Help us to get to know you better. Be yourself. There is no right or wrong answers. Please type your answers on a separate sheet in English and attach to the application form. Write your name and school as well as the date in the corner of each page. 1. Tell us the field of study that interests you. Why? How did your interest develop? 2. How are you going to apply the knowledge from your courses in your work after university to benefit the country? 3. Choose three adjectives to describe yourself. Comment briefly on your choice 4. Why do you think you are the right person to receive the Goodwill Leadership Development Scholarship Award? 5. If you receive a Goodwill scholarship award, are you willing to participate in Goodwill activities, including our training programs and meet the sponsor gathering? If you answer is yes, how are you going to arrange your time as you may have classes and other activities? 6. If you would like the Goodwill Committee to know any special circumstances not reflected in your application, please describe.
9.
Profile
In order to attract prospective sponsors to support your education, we have to write your profile. Please help us to write a concise profile for the purpose of convincing the perspective sponsors to support your education. Include your background, achievement, experiences and activities, and why it should be attractive to the prospective sponsors. Please, note that writing your own profile is like writing a short essay about yourself. We dont want your CV.
10.
Essays
Your essays are a very important part of your application. We want to get to know you. We also want to see how well you present yourself. For each question below, please type a one page essay with approximately 300400 words in English. Make sure to put your name and your school as well as the date in the corner of each page. Attach the essays to your application form. Note: One essay answering three questions is not acceptable. 1. Name a non-religious figure, person (other than your family), place, book or event that has affected you and caused you to change your outlook on life. 2. Describe an experience that has given you a sense of satisfaction or pride. Explain why you were satisfied or proud. 3. Describe a situation or activity in which you took a leadership role. What qualities do you possess that distinguish you as a leader?
