Japan Indonesia Presidential Scholarships Program (JIPS)

2010 Application Form

THE WORLD BANK

Japan Indonesia Presidential Scholarships Program Applicant Information: 2010 Cycle Introduction Funded by a grant from the government of Japan, the Japan Indonesia Presidential Scholarships Program (JIPS) supports PhD studies in an academic field of study covered by Indonesian Centers of Excellence (CoE) participating in the program. Each of these newly established Centers of Excellence is located at a leading higher education institution in the country with a demonstrated track record in the pursuit of excellence. The goal of the program is to promote excellence in research in these Centers to support the Ministry of National Education in its mission to improve the quality of higher education and research in the country. The purpose of the scholarship is to support scholarship recipients in upgrading their qualifications and to provide them with an international study experience at renowned academic institutions in World Bank member countries, except Indonesia. During their studies, scholars are encouraged to build and foster academic collaborations and partnerships. Upon completion of their studies, the selected candidates commit to work in the sponsoring CoE and play an active role in its academic life. The Centers of Excellence and disciplines covered by the JIPS are as follows:

Institution

Center of Excellence

Bandung Institute of Technology Gadjah Mada University

Biotechnology

Indonesia University of Education

Special Needs Education

Good Corporate Governance

Bio-energy Institute of Agriculture Bogor (IPB) Bio-industry and Business

Open University

Distance Learning

Parahyangan Catholic University

Small and Medium Enterprise Development (SME) Infrastructure & Urban Development

Economic Policy University of Indonesia Reproductive Health

Eligible Disciplines

Contact

Environmental Engineering, Bioinformatics, Plant metabolomics and bioprocess Transparency and Disclosure, Disclosure and Accountability, Transparency and Social Responsibility for Transnational Corporation, Corporate Responsibility Education (Visual Impairment, Hearing Impairment, Students with Intellectual Disability, Physical Impairment) Biomolecular plant breeding, Plant Protection, Marine products-based bioenergy production, Biofuel processing development Essential oil technology, Rubber and polymer technology, Sugar and sucrochemical technology, Leather technology, Business and commercialization of technology Management of distance education

[email protected]

Industrial Engineering, Product Design and Development, International Political Economy, Accounting, Economics and Business Administration, Management, Commerce/International Business Water Resources Planning & Management, Infrastructure Management, Architecture Design & Engineering, Urban Design & Architecture, Hydro informatics, Knowledge management Economics, Public Management, Accountancy

[email protected]

Medicine, Biology, Public Health

[email protected]

-2-

[email protected]

[email protected]

[email protected]

[email protected]; [email protected]

[email protected]

[email protected]

[email protected]; [email protected]

Length of Scholarship Between three and four years.

Scholar’s Commitment Be committed to work as professor/researcher in the Centers of Excellence endorsing the scholarship upon completion of the PhD Program.

Eligibility Applicants must meet the following general criteria to be eligible for a scholarship: •

be a national and resident of Indonesia

•

be under 45 years at application deadline.

•

must have completed and been awarded a master's degree, or equivalent, at the time of application however, outstanding candidates with a bachelor degree can be considered for a Master-PhD track

•

have maintained a GPA of at least 3 on a scale of 4 in both undergraduate and graduate studies

Application Procedures Application forms and information about the application procedure are available in the participating Centers of Excellence, and on the World Bank Scholarship Program website at www.worldbank.org/scholarships. Interested candidates should submit application packages by March 26, 2010 to the relevant Center of Excellence of their choice using the contact information provided in Attachment B. Preselected candidates will be invited to an interview end of April 2010. For specific inquiries about the scholarship positions and additional selection criteria, interested candidates are invited to contact the respective Center of Excellence directly. For general inquiries, the Program Office can also be contacted at: Japan Indonesia Presidential Scholarships Program The World Bank MSN J4-402 1818 H St. NW Washington DC, 20433, USA email: [email protected]

-3-

Instructions for Completing the Application Form There are 7 sections in this application. • • • • • • •

Personal Data Academic Background University Study Program Work Experience Relevance of Proposed Research Activity References Checklist

A. Personal Data: Page 1 •

Underline the name by which you would be addressed with a title, e.g., Satrio Sudiatmo = Mr. Satrio

•

You must submit proof of your nationality with the application

•

You must also submit proof of your date of birth Note: applicants must be under 45 years at application deadline

B. Academic Background: Page 2 In this section you should list your highest degree first, followed by postgraduate diplomas and undergraduate degree. Send a copy of your highest degree. If applicable, please include copies of all post-graduate diplomas. Please write out the complete title of your degree, along with the acronym. All certificates must be translated into English.

C. University Study Program: Pages 3 In section C.1 you should indicate if you have admission to a master’s degree, PhD or None. In Section C.2 you should indicate two preferences of universities where you would like to pursue your studies.

D. Work Experience: Pages 6 In Section D.1 you should indicate if you are currently a staff in one of the Centers of Excellence. In Section D.2 you should give detailed information on each full-time position held by you, listing your current or most recent occupation first. Emphasis should be given to activities with particular relevance to your research.

-4-

E. Relevance of Proposed Study Program: Page 9 Please provide a brief description of the objectives and potential contribution of your study program. We would also like you to specify the relevance of this study program to your past professional experience and future career goals.

F. References: Page 10 Please provide the names and addresses of two or more individuals who will provide us with reference letters. Special forms for “Letters of Reference” are provided in Attachment A. We strongly recommend that you enclose the sealed letters of reference along with your completed application package, to eliminate the possibility of late arrival. In all cases, the letters of Reference need to arrive no later than the application deadline, March 26, 2010. You should select referees who are competent to comment on: • • • •

Your academic strengths and achievements Your professional experience in teaching and research Your ability to successfully complete the doctoral study you propose The relevance of the proposed program of study to the corresponding CoE

Letters must be dated within 3 months of their submission to the Program.

G. Checklist: Page 11 All specified enclosures must be included in the completed application package.

-5-

Applicant’s Name:

______________________________________________________________________ Family/Last Name First Name Middle Name

Japan Indonesia Presidential Scholarships Program 2010 Application Form A. Personal Data: Summary 1. Name:________________________ Last (Family) 2. Gender: Male _______

_________________________ First

Female ________

______________________ Middle

3. Nationality: __________________________

4. Permanent Address: _______________________________________________________________ (Street Address) ___________________________________________________________________________________ (City) (State/Region) (Postal Code) (Country) Telephone: __________________________________

Fax: __________________________________

E-mail: _____________________________________________________________________________ 5. Current Address: __________________________________________________________________ (if different from above) (Street Address) __________________________________________________________________ (City) (State/Region) (Postal Code) (Country) Telephone: __________________________________

Fax: __________________________________

Telephone (Office):____________________________

Fax (Office): ___________________________

E-mail: _____________________________________________________________________________ 6. Date of Birth: ______________________________ 7. Age: ______________________________ (Day) (Month) (Year) 8. Highest Degree Held: ______________________

9. Degree in Progress: __________________ Expected Date of Completion: __________

10. Current Occupation (Please mark one):

11. Education level of your parents: No Education Primary Secondary University

_______ Academic _______ Public Sector (other than academic) _______ Private Sector _______ Regional or International Organization _______ NGO _______ Consultant _______ Other, please specify: ______________________

Mother _______ _______ _______ _______

Father _______ _______ _______ _______

Japan Indonesia Presidential Scholarships Program - The World Bank 1818 H Street, N.W., MSN J4-402, Washington, D.C. 20433, USA -1-

Applicant’s Name:

______________________________________________________________________ Family/Last Name First Name Middle Name

B. Academic Background (highest degree first)

Name of Institution: ___________________________________________________________________ Address: ____________________________________________________________________________ ___________________________________________________________________________________ Duration of the Degree Program: __________________ Dates Attended: From: _______ To: ________ month/year month/year Degree Awarded: _____________________________________________________________________ Subjects/Field: _______________________________________________________________________

Name of Institution: ___________________________________________________________________ Address: ____________________________________________________________________________ ___________________________________________________________________________________ Duration of the Degree Program: __________________ Dates Attended: From: _______ To: ________ month/year month/year Degree Awarded: _____________________________________________________________________ Subjects/Field: _______________________________________________________________________

Name of Institution: ___________________________________________________________________ Address: ____________________________________________________________________________ ___________________________________________________________________________________ Duration of the Degree Program: __________________ Dates Attended: From: _______ To: ________ month/year month/year Degree Awarded: _____________________________________________________________________ Subjects/Field: _______________________________________________________________________

Japan Indonesia Presidential Scholarships Program - The World Bank 1818 H Street, N.W., MSN J4-402, Washington, D.C. 20433, USA -2-

Applicant’s Name:

______________________________________________________________________ Family/Last Name First Name Middle Name

C.1 University Study Program Do you have admissions to: Master’s Degree

PhD

None

University Admission (1): University: ________________________________________________________________ Degree Name: ______________________________________________________________ Start Date (mm/yyyy): _______________ End Date (mm/yyyy): ______________________ Contact Person: _______________________________ Title: ________________________ (Family/Last Name) (First Name) Office Telephone: ______________________ Fax: __________________________ Email: ____________________________________________________________________

University Admission (1): University: ________________________________________________________________ Degree Name: ______________________________________________________________ Start Date (mm/yyyy): _______________ End Date (mm/yyyy): ______________________ Contact Person: _______________________________ Title: ________________________ (Family/Last Name) (First Name) Office Telephone: ______________________ Fax: __________________________ Email: ____________________________________________________________________

Japan Indonesia Presidential Scholarships Program - The World Bank 1818 H Street, N.W., MSN J4-402, Washington, D.C. 20433, USA -3-

Applicant’s Name:

______________________________________________________________________ Family/Last Name First Name Middle Name

Language proficiency rating Language

Excellent

Good

Fair

English Other (specify) Other (specify) Other (specify) Other (specify)

Standard Tests Test

Date

TOEFL GRE GMAT IELTs Other (specify)

Japan Indonesia Presidential Scholarships Program - The World Bank 1818 H Street, N.W., MSN J4-402, Washington, D.C. 20433, USA -4-

Score

Applicant’s Name:

______________________________________________________________________ Family/Last Name First Name Middle Name

C.2 University Study Program In case you need a university admission, please indicate below your preferences in order of priority:

University Admission (First Preference) University/Institution name: _____________________________________________________________ Faculty/School/Department _____________________________________________________________ Lab/Research team: __________________________________________________________________ Have you already started the application process? Yes

No

If yes, is there a contact person? ________________________________________________________ (Family/Last Name)

(First Name)

Title: _______________________________________________________________________________ Office Telephone: _____________________________

Fax: ________________________________

Email: ______________________________________________________________________________

University Admission (Second Preference) University/Institution name: _____________________________________________________________ Faculty/School/Department _____________________________________________________________ Lab/Research team: __________________________________________________________________ Have you already started the application process? Yes

No

If yes, is there a contact person? ________________________________________________________ (Family/Last Name)

(First Name)

Title: _______________________________________________________________________________ Office Telephone: _____________________________

Fax: ________________________________

Email: ______________________________________________________________________________

Japan Indonesia Presidential Scholarships Program - The World Bank 1818 H Street, N.W., MSN J4-402, Washington, D.C. 20433, USA -5-

Applicant’s Name:

______________________________________________________________________ Family/Last Name First Name Middle Name

D1. Work Experience Are you currently a staff in one of the following Centers of Excellence? Yes

No

If you answered yes to the question above, indicate the position and start date of service in the corresponding line:

Institution

Center of Excellence

Bandung Institute of Technology

Biotechnology

Gadjah Mada University

Good Corporate Governance

Indonesia University of Education

Special Needs Education

Institute of Agriculture Bogor (IPB)

Bio-energy

Position Held

Bio-industry and Business Open University

Distance Learning Development of SME

Parahyangan Catholic University University of Indonesia

Infrastructure & Urban Development Economics Reproductive Health

Japan Indonesia Presidential Scholarships Program - The World Bank 1818 H Street, N.W., MSN J4-402, Washington, D.C. 20433, USA -6-

Date of Service

Applicant’s Name:

______________________________________________________________________ Family/Last Name First Name Middle Name

D.2 Other Work Experience (begin with current or most recent position) Give a record of each of the last full-time positions held (most recent first). This application form includes two pages (6 and 7) for information on your employment history. List part-time jobs, community service and other activities on page 8.

Organization: _________________________________________________________ Public Sector

Private Sector

NGO

Regional or International Organization

Address: ____________________________________________________________________________ ___________________________________________________________________________________ Telephone: ___________________________________ Fax/E-Mail _____________________________ Title of Supervisor’s your Position __________________________________ Name: ________________________________ Dates of Service: From: _________________________ To: ___________________________________ (month/year) (month/year) Please provide details of your professional responsibilities, project(s) undertaken, and other professional accomplishments in the space below.

Organization: _________________________________________________________ Public Sector

Private Sector

NGO

Regional or International Organization

Address: ____________________________________________________________________________ ___________________________________________________________________________________ Telephone: ___________________________________ Fax/E-Mail _____________________________ Title of Supervisor’s your Position __________________________________ Name: ________________________________ Dates of Service: From: _________________________ To: ___________________________________ (month/year) (month/year) Please provide details of your professional responsibilities, project(s) undertaken, and other professional accomplishments in the space below.

Japan Indonesia Presidential Scholarships Program - The World Bank 1818 H Street, N.W., MSN J4-402, Washington, D.C. 20433, USA -7-

Applicant’s Name:

______________________________________________________________________ Family/Last Name First Name Middle Name

Part-time jobs, community service, and other relevant activities. ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________

Other information, related to your professional and personal development, which is relevant to your application. ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________

Japan Indonesia Presidential Scholarships Program - The World Bank 1818 H Street, N.W., MSN J4-402, Washington, D.C. 20433, USA -8-

Applicant’s Name:

______________________________________________________________________ Family/Last Name First Name Middle Name

E. Relevance of Proposed Studies 1. Please specify briefly the research topic you intend to address in your doctoral study (150 words maximum).

___________________________________________________________________________________ 2. Please specify the relevance of the proposed research activity to your past professional experience, and future academic career (150 words maximum).

Japan Indonesia Presidential Scholarships Program - The World Bank 1818 H Street, N.W., MSN J4-402, Washington, D.C. 20433, USA -9-

Applicant’s Name:

______________________________________________________________________ Family/Last Name First Name Middle Name

F. References Name: _________________________________________ Title: ____________________________________ Address: _________________________________________________________________________________ (Street Address) ________________________________________________________________________________________ (City) (State/Region) (Postal Code) (Country) Telephone: ______________________________________ Fax: ____________________________________ Email: ___________________________________________________________________________________ In what capacity do you know this referee? ________________________________________________

Name: _________________________________________ Title: ____________________________________ Address: _________________________________________________________________________________ (Street Address) ________________________________________________________________________________________ (City) (State/Region) (Postal Code) (Country) Telephone: ______________________________________ Fax: ____________________________________ Email: ___________________________________________________________________________________ In what capacity do you know this referee? ________________________________________________

Japan Indonesia Presidential Scholarships Program - The World Bank 1818 H Street, N.W., MSN J4-402, Washington, D.C. 20433, USA -10-

Applicant’s Name:

______________________________________________________________________ Family/Last Name First Name Middle Name

G. Checklist You must submit the completed application form and attach the following documents •

Copy of your highest degree and proof of any additional post-graduate diplomas

•

Admission to a master’s degree or PhD program

•

Two letters of reference (Attachment A)

•

A current or updated curriculum vitae not exceeding two pages

•

Proof of nationality

•

Proof of date of birth

All certificates must be translated into English. I certify that the information contained in this application form is accurate to the best of my knowledge. If awarded a Fellowship, I agree to abide by the terms of the award and to undertake the program essentially as outlined in this proposal. I also understand and accept that the World Bank reserves the right to publish the product of my study or research. Please note that applicants are responsible for obtaining all clearances that may be required to undertake the proposed study or research, including any necessary clearance or permission of the Government of Indonesia and of your employer.

___________________________________ (Signature)

____________________ (Date)

Applications must reach the Japan Indonesia Presidential Scholarships Program Office at the following address, no later than March 26, 2010, to be considered for the 2010 Cycle. Faxed applications are not accepted.

Japan Indonesia Presidential Scholarships Program - The World Bank 1818 H Street, N.W., MSN J4-402, Washington, D.C. 20433, USA -11-

Applicant’s Name:

______________________________________________________________________ Family/Last Name First Name Middle Name Japan Indonesia Presidential Scholarships Program The World Bank, 1818 H Street, N.W. MSN J4-402 Washington D.C., 20433, U.S.A.

Attachment A

LETTER OF REFERENCE (Professional or Academic) Referee’s Name: _______________________________________________________________________ Title:

_______________________________________________________________________________

Organization: __________________________________________________________________________ Address: ______________________________________________________________________________ Telephone: ___________________________________ Fax _____________________________________ E-Mail

_______________________________________________________________________________

1. How long have you known the applicant? __________________________________________________ 2. In what capacity? ____________________________________________________________________ To the Referee: Your assessment of the above-named applicant is an important part of the scholarship program’s review process. The questions posed below represent the kind of information which the reviewers find useful, but you are welcome to give us your views in whatever format you find most suitable. The letter of recommendation is confidential. Please return the completed form/letter to the applicant in a sealed envelope with your signature across the flap.

Applications must be received, no later than March 26, 2010, to be considered for the 2010 Cycle. Faxed applications are not accepted.

Japan Indonesia Presidential Scholarships Program - The World Bank 1818 H Street, N.W., MSN J4-402, Washington, D.C. 20433, USA -1-

Applicant’s Name:

______________________________________________________________________ Family/Last Name First Name Middle Name

1.

Please describe the applicant’s academic or professional strengths and achievements.

2.

On a scale of 1 to 3, with 1 being the highest, what is your assessment of the applicant’s academic preparation to successfully carry out the proposed doctoral study? In addition to your rating, we are interested in having your viewpoint on this important factor.

Rating Scale (Please Circle):

1

2

Japan Indonesia Presidential Scholarships Program - The World Bank 1818 H Street, N.W., MSN J4-402, Washington, D.C. 20433, USA -2-

3

Applicant’s Name:

3.

______________________________________________________________________ Family/Last Name First Name Middle Name

Additional Comments.

Signature of Referee ____________________________________ Date:________________________

Japan Indonesia Presidential Scholarships Program - The World Bank 1818 H Street, N.W., MSN J4-402, Washington, D.C. 20433, USA -3-

Attachment B CoE Contact Information CoE

Contact Person

Title

Office Telp/HP

Email

Mailing Address

BANDUNG INSTITUTE OF TECHNOLOGY Biotechnology

Dr. Maelita R. Moeis

Coordinator of the COE of Biotechnology

022 2500 258/ 0813 22360 525

[email protected]

SITH ITB, Gedung LABTEK XI Jl. Ganesha No. 10 Bandung, West Java Indonesia 40132

Dr. Sony Warsono

Executive DirectorCenter for Good Governance

0274 548 550/ 08179423068

[email protected]

Centre for Good Corporate Governance Fakultas Ekonomika & Bisnis Universitas Gadjah Mada Jl. Sosio Humaniora No. 1 Bulak Sumur DI Yogyakarta Indonesia 55281

Dr. Djaja Rahardja

Coordinator of the COE of Special Needs Education

022 201 3161/ 0818 426 532

[email protected]

Fakultas Ilmu Pendidikan Jurusan Pendidikan Luar Biasa Jl. Dr. Setiabudhi No. 229 Bandung, West Java, Indonesia 40154

GADJAH MADA UNIVERSITY Good Corporate Governance

INDONESIA UNIVERSITY OF EDUCATION Special Needs Education

Japan Indonesia Presidential Scholarships Program - The World Bank 1818 H Street, N.W., MSN J4-402, Washington, D.C. 20433, USA

Attachment B CoE Contact Information

CoE

Contact Person

Title

Office Telp/HP

Email

Mailing Address

INSTITUTE OF AGRICULTURAL BOGOR (IPB) Bio-Energy

Dr Ir. Anas M. Fauzi

Vice-Rector for Research and Collaboration

0251 8622 637/ 0811 1185 08

[email protected]

Bio-Industry and Business

Dr Muhammad Agil

Head of Sub Directorate for International Programs

0251 8622 638/ 0812 950 5081

[email protected]; [email protected]

Dr Tian Belawati

Vice-Rector for Academic Affairs

021 749 0941 ext 1105

[email protected]

Wakil Rektor Bidang Research & Kerjasama Gedung Andi Hakim Nasuton 2nd Floor Kampus IPB Rektorat Jl. Raya Darmaga Bogor West Java Indonesia 16680 Direktorat Kerja Sama & Progoram International Gedung Andi Hakim Nasuton 2nd Floor Kampus IPB Rektorat Jl. Raya Darmaga Bogor West Java Indonesia 16680

OPEN UNIVERSITY Distance Learning

Japan Indonesia Presidential Scholarships Program - The World Bank 1818 H Street, N.W., MSN J4-402, Washington, D.C. 20433, USA

Gedung Rektorat 1st Floor, Jl. Cabe Raya, Pondok Cabe, Tangerang Banten West Java Indonesia 15418

Attachment B CoE Contact Information CoE PARAHYANGAN CATHOLIC UNIVERSITY

Contact Person

Title

Infrastructure & Urban Development

Prof Robertus Wahyudi Triweko, Ph. D

Coordinator of the COE of Infrastructure & Urban Development

Small and Medium Enterprise Development

Prof Anak Agung Banyu Perwita Ph. D.

Economic Policy

Reproductive Health

Office Telp/HP

Email

Mailing Address

022 203 691/ 0812 232 7972

[email protected]

Vice Rector for Relations and Cooperation

022 203 2655/ 2032576 ext. 100/ 0812 204 4951

[email protected]

Gedung Dekanat Fakultas Teknik UNPAR Jl. Cimbeleuit No. 94 Bandung West Java Indonesia 40141 Gedung Rektorat UNPAR 2nd Floor Jl. Cimbeleuit No. 94 Bandung West Java Indonesia 40141

Dr. Jossy P. Moeis and Dr. Firmanzah

Manager Research Community Service and Academic Development

0811904751/ 727 2425

[email protected] and [email protected]

Dr Budi Wiweko

Head of the COE of Reproductive Health

0816 144 0025

[email protected]

UNIVERSITY OF INDONESIA

Japan Indonesia Presidential Scholarships Program - The World Bank 1818 H Street, N.W., MSN J4-402, Washington, D.C. 20433, USA

Manager Research & Pengabdian Masyarakat Gedung Dekanat Fakultas Ekonomi, Universitas Indonesia Kampus UI Depok West Java Indonesia 16424 Department of Obstetry & Gynecology Fakultas Kedokteran UI/RSCM Jl. Diponegoro No. 71 Jakarta Pusat Indonesia 10340