Field of Training
Program
to Extend Scholarships and Training to Achieve Sustainable Impacts Phase II
(PRESTASI II) provides opportunities for Indonesians to earn Master’s degrees
which focus on areas that are relevant to the achievement of USAID/Indonesia
and Government of Indonesia development goals.
PRESTASI
II offers fields of training as follows: Education, Health and Environment.
Indicate your preference(s) by filing in the number 1-3 on the left column. The
number should reflect your priority rank of the proposed field of study. You may
choose up to 3 options under the same Field of Training.
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Environment – Indonesian University
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Water
and Sanitation
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Sustainable
Forest Management, Agro-forestry and Community Forestry
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Marine
and Coastal Zone Management
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Agribusiness,
Agricultural Economics and Agricultural Biotechnology Policy
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Public
Policy
|
List of Required Documents
|
Mandatory Documents
Please
put check mark (ü) if you have attached the following documents
in support of your application
|
||||
|
1.
|
Completed and signed application form
|
1 original and 3 copies
|
o
|
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|
2.
|
Certified
Undergraduate Certificate
|
1 original and 3 copies
|
o
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3.
|
Certified
Undergraduate Academic Transcripts
|
1 original and 3 copies
|
o
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4.
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Recent photographs (4 x 6, B/W or color)
|
4 copies
(attach to each copy of application
form)
|
o
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5.
|
Recent Curriculum Vitae (in English)
|
4 copies
(attach to each copy of application
form)
|
o
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6.
|
Copy of valid national ID Card (KTP or Passport)
|
1 copy
|
o
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7.
|
Valid TOEFL® ITP or TOEFL®
IBT or IELTS™ scores result
|
1 copy
|
o
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8.
|
Original Reference Letters, in sealed envelopes
|
3 copies
|
o
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Supplementary Documents
Please put
check mark (ü) if you
are attaching the following documents in support of your application
|
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|
9.
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Copy of certificates
and awards
|
1 copy
|
o
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10..
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Copy of article,
journal, research, or cover page of your publication etc.
|
1 copy
|
o
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Important
·
Do not
submit original documents.
·
Application
forms and attached documents will not be returned.
·
No
mandatory and/or supplementary documents can be delivered separately from the
application forms, except the Reference Letters.
·
You
do not need to translate the academic transcript and certificate to English.
To expedite the process, please pay attention to the following
instruction below:
Put together all documents and arrange
them into 4 separate sets. Each set should contain documents as described above and every set should be in the same order.
Please see below example:
4 4 4 4
Original
Form Copy 1 Copy 2
Copy 3
(No 1
– 10) (No 1 – 5) (No 1 – 5)
(No 1 – 5)
Please
do not bind the documents. Please use
paper clips to expedite the dividing process.
From where did you first
hear about PRESTASI?
|
□ Newspaper or magazine
|
□ Television
|
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□ Brochure or flyer
|
□ Radio
|
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□ Education Fair or presentation session
|
□ Internet or mailing list
|
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□ Social media (Facebook or Twitter)
|
□ Advertisement at university
|
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□ Other, please specify: _________________________________________
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Application
Delivery
Application packages should be delivered via post / mail or
hand-delivered to IIEF office to the below address:
USAID
Scholarship PRESTASI Program
Menara
Imperium, 28th Fl. Suite A
Jl. HR Rasuna
Said Kav.1, Kuningan, Jakarta 12980
The application packages should arrive at IIEF office at the
latest on March 14, 2014, before 4.30 PM.
No documents are allowed to be sent via email or fax. Late or incomplete
application will not be considered.
Early application submission is
highly recommended.
1.
PERSONAL INFORMATION
Please give your personal
details exactly as it appears on official documents (National ID, Passport,
Birth Certificate, etc.). Each field is mandatory.
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First Name
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Please attach a recent
photo (color or B/W)
4 x 6
|
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Middle
Name
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Last
Name
|
*if you
have only one name, please write down your name in the Last Name section
|
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National
ID Details: (check
only one box below)
□KTP
□Passport
No:_________________________________
Expiry Date
(DD/MM/YY):_______________
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Date of Birth (DD/MM/YY)
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Place
of Birth
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Gender
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Male □ Female □
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Nationality
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Residential
Address:
|
City
|
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Province
|
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Postal
Code
|
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Home
phone no.
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*please write down the code area
|
Mobile no.
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Email
|
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Marital
Status
|
□Single □Married □Widow/widower
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2.
PHYSICAL IMPAIRMENT INFORMATION (if
applicable)
|
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Category
|
o Visual impairment
|
o Hearing impairment
|
o Physical
impairment
|
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Please specify
|
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Special needs
identification
(Please
identify support that you need from USAID PRESTASI, in order to be successful
in your future study. For example: wheel chair, special communication devices
and Braille computer)
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3.
EMERGENCY
CONTACT
Details of
a person that we can contact in case of emergency. You should provide
2 emergency contacts.
|
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Name
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Residential
Address:
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City
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Province
|
|
||||
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Postal
Code
|
|
||||
|
Home
Phone
|
*please
write down the code area
|
Mobile
Phone
|
|
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Email
Address
|
|
||||
|
Relationship
to you
|
|
||||
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|
|||||
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Name
|
|
||||
|
Residential
Address:
|
City
|
|
|||
|
Province
|
|
||||
|
Postal
Code
|
|
||||
|
Home
Phone
|
*please
write down the code area
|
Mobile
Phone
|
|
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Email
Address
|
|
||||
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Relationship
to you
|
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4.
ENGLISH
LANGUAGE PROFICIENCY
Please check only one box below and attach the
copy of certificate. Prediction test is not allowed.
|
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Type
of test
|
□TOEFL® ITP □ TOEFL® IBT □ IELTS™
|
Overall
score
|
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Date
of test taken
(DD/MM/YY)
|
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Test
Location
|
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5.
PROPOSED
FIELD OF TRAINING
Please refer to the Field of Training
section on page 1 in this Application Form. You are allowed to propose up
to 3 choices in rank order. The proposed field of study must be under the
same Field of Training. If you are awarded the scholarship, you may not be
permitted to make changes.
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First Priority
|
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|
Field
of Training
|
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Location
of study*
|
□ Indonesian University
□ U.S. University
|
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Briefly describe the reason why you choose
the above study. It should not be more than 100 words. Additional paper is
not allowed. This section is mandatory.
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Second Priority
|
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|
Field
of Training
|
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Location
of study*
|
□ Indonesian
University
□ U.S. University
|
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Briefly describe the reason why you choose
the above study. It should not be more than 100 words. Additional paper is
not allowed. This section is mandatory.
|
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Third Priority
|
|||
|
Field
of Training
|
|
Location
of study*
|
□ Indonesian
University
□ U.S. University
|
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Briefly describe the reason why you choose
the above study. It should not be more than 100 words. Additional paper is
not allowed. This section is mandatory.
|
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6.
PROPOSED UNIVERSITY
If you have no particular preferences and would like PRESTASI to
identify a suitable institution for you, proceed to section 7.
|
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|
First
Choice of University
|
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Name
of University
|
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Complete Address:
|
||||||||
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Faculty
/ Department
|
|
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|
Have you requested admission to the university
|
□Yes □No
|
Have you received an admission from the
university
*if yes, attached the Letter of Admission
|
□Yes □No
|
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Are you receiving or applying to get funding support
|
□Yes □No
|
If receiving, please specify the amount
|
|
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Contact Person
|
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Email
|
|
|||||||
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Second
Choice of University
|
||||||||||
|
Name
of University
|
|
Complete
Address:
|
||||||||
|
Faculty
/ Department
|
|
|||||||||
|
Have you requested admission to the university
|
□Yes □No
|
Have you received an admission from the
university
*if yes, attached the Letter of Admission
|
□Yes □No
|
|||||||
|
Are you receiving or applying to get funding support
|
□Yes □No
|
If receiving, please specify the amount
|
|
|||||||
|
Contact Person
|
|
Email
|
|
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|
7.
EDUCATIONAL BACKGROUND
List of universities and
colleges attended. Start with the most recent one. If you are in the process
of finishing your study or attended graduate program but not completed,
please indicate in the below table.
|
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|
a. Name
of Institution
|
|
Degree
Obtained
|
|
||||
|
City
|
|
Country
|
|
||||
|
Faculty
|
|
Major
|
|
||||
|
Start
Date (MM/YY)
|
|
End Date
(MM/YY)
|
|
GPA
|
|
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|
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|
EDUCATIONAL BACKGROUND (continued)
|
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|
b. Name
of Institution
|
|
Degree
Obtained
|
|
||||
|
City
|
|
Country
|
|
||||
|
Faculty
|
|
Major
|
|
||||
|
Start
Date (MM/YY)
|
|
End Date
(MM/YY)
|
|
GPA
|
|
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|
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c. Name
of Institution
|
|
Degree
Obtained
|
|
||||
|
City
|
|
Country
|
|
||||
|
Faculty
|
|
Major
|
|
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Start
Date (MM/YY)
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End Date
(MM/YY)
|
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GPA
|
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d. Name
of Institution
|
|
Degree
Obtained
|
|
||||
|
City
|
|
Country
|
|
||||
|
Faculty
|
|
Major
|
|
||||
|
Start
Date (MM/YY)
|
|
End Date
(MM/YY)
|
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GPA
|
|
||
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e. Name
of Institution
|
|
Degree
Obtained
|
|
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|
City
|
|
Country
|
|
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|
Faculty
|
|
Major
|
|
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Start
Date (MM/YY)
|
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End Date
(MM/YY)
|
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GPA
|
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8.
SCHOLARSHIP HISTORY
Please record any scholarship or fellowship that you received in
the past, starting from the university level. Additional paper is allowed if
necessary.
|
|||||||||||
|
Have you ever received any
scholarship or other funding support from any institution? □Yes □No
*if no, proceed to the
next section
|
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|
Scholarship
title
|
|
Level
of
Education
|
|
||||||||
|
Start date (DD/MM/YY)
|
|
End Date (DD/MM/YY)
|
|
||||||||
|
Scholarship
Provider
|
|
Contact Person
(Name & Email)
|
|
||||||||
|
Funding
|
□Full
□Partial
|
Type
of scholarship
|
□Degree □Non – degree
|
||||||||
|
|
|||||||||||
|
Scholarship
title
|
|
Level
of
Education
|
|
||||||||
|
Start date (DD/MM/YY)
|
|
End Date (DD/MM/YY)
|
|
||||||||
|
Scholarship
Provider
|
|
Contact Person
(Name & Email)
|
|
||||||||
|
Funding
|
□Full □Partial
|
Type
of scholarship
|
□Degree □Non – degree
|
||||||||
|
|
|||||||||||
|
Scholarship
title
|
|
Level
of
Education
|
|
||||||||
|
Start date (DD/MM/YY)
|
|
End Date (DD/MM/YY)
|
|
||||||||
|
Scholarship
Provider
|
|
Contact Person
(Name & Email)
|
|
||||||||
|
Funding
|
□Full □Partial
|
Type
of scholarship
|
□Degree □Non – degree
|
||||||||
|
|
|||||||||||
|
Scholarship
title
|
|
Level
of
Education
|
|
||||||||
|
Start date (DD/MM/YY)
|
|
End Date (DD/MM/YY)
|
|
||||||||
|
Scholarship
Provider
|
|
Contact Person
(Name & Email)
|
|
||||||||
|
Funding
|
□Full □Partial
|
Type
of scholarship
|
□Degree □Non – degree
|
||||||||
|
9.
EMPLOYMENT HISTORY
List your work experiences
since university until present. Start with the most current one.
Additional paper is allowed if necessary.
|
|||||||||
|
a. Name
of
Institution
|
|
Position
Title
|
|
||||||
|
Full
Address :
|
Start
date (MM / YY)
|
|
|||||||
|
End
date (MM / YY)
|
|
||||||||
|
Phone
|
*please
write down the code area
|
Email
address
|
|
||||||
|
Employment
category
|
□ Government Institution
□ Research
Institution
□ University /
School
|
□ Private Institution
□ Media
□ NGO
|
□ Entrepreneur /
Freelance
□ Other, please
state:
___________________________
|
||||||
|
Responsibility:
|
Level of staffing:
□ Low rank
□ Middle rank
□ Top management
□ Not applicable
|
||||||||
|
|
|||||||||
|
b. Name
of
Institution
|
|
Position
Title
|
|
||||||
|
Full
Address :
|
Start
date (MM / YY)
|
|
|||||||
|
End
date (MM / YY)
|
|
||||||||
|
Responsibility:
|
|||||||||
EMPLOYMENT HISTORY (continued)
|
||||
|
c. Name
of
Institution
|
|
Position
Title
|
|
|
|
Full
Address :
|
Start
date (MM / YY)
|
|
||
|
End
date (MM / YY)
|
|
|||
|
Responsibility:
|
||||
|
10.
COMMUNITY SERVICES ACTIVITIES
List professional, societal or
other organizations in which you now hold membership or have been active in
the past. You are allowed to use additional paper if necessary.
|
|||
|
a. Name
of institution
|
|
||
|
Start
date (MM/YY)
|
|
Address:
|
|
|
End date
(MM/YY)
|
|
||
|
Position
|
|
||
|
Responsibility:
|
|||
|
|
|||
|
b. Name
of institution
|
|
||
|
Start
date (MM/YY)
|
|
Address:
|
|
|
End date
(MM/YY)
|
|
||
|
Position
|
|
||
|
Responsibility:
|
|||
COMMUNITY
SERVICES ACTIVITIES (continued)
|
|||
|
c. Name
of institution
|
|
||
|
Start
date (MM/YY)
|
|
Address:
|
|
|
End date
(MM/YY)
|
|
||
|
Position
|
|
||
|
Responsibility:
|
|||
|
11.
PUBLICATIONS AND ARTICLES
List of
publications and articles relevant to your application. Please attach the
copy of your articles or the cover page of your publications. You can
use additional paper if you need more space. If it is not applicable,
please proceed to the next section.
|
|||
|
a. Title
|
|
||
|
Publication
date
|
|
Publisher’s
name
|
|
|
Co –
writer (if applicable)
|
|
||
|
|
|||
|
b. Title
|
|
||
|
Publication
date
|
|
Publisher’s
name
|
|
|
Co –
writer (if applicable)
|
|
||
|
|
|||
|
c. Title
|
|
||
|
Publication
date
|
|
Publisher’s
name
|
|
|
Co –
writer (if applicable)
|
|
||
|
|
|||
|
d. Title
|
|
||
|
Publication
date
|
|
Publisher’s
name
|
|
|
Co –
writer (if applicable)
|
|
||
|
12.
AWARDS
List of significant awards and
accomplishments relevant to your application, starting from university
level. Please use additional paper, if you need more space. If it is not
applicable, please proceed to the next section.
|
|||
|
a. Name
of award
|
|
||
|
Year of
award
|
|
Scope
of award
|
□ District level □ National level
□ Regional level □ International
level
|
|
Award
provider
|
|
||
|
|
|||
|
b. Name
of award
|
|
||
|
Year of
award
|
|
Scope
of award
|
□ District level □ National level
□ Regional
level □ International level
|
|
Award
provider
|
|
||
|
|
|||
|
c. Name
of award
|
|
||
|
Year of
award
|
|
Scope
of award
|
□ District level □ National level
□ Regional
level □ International level
|
|
Award
provider
|
|
||
|
|
|||
|
d. Name
of award
|
|
||
|
Year of
award
|
|
Scope
of award
|
□ District level □ National level
□ Regional
level □ International level
|
|
Award
provider
|
|
||
|
|
|||
|
e. Name
of award
|
|
||
|
Year of
award
|
|
Scope
of award
|
□ District level □ National level
□ Regional
level □ International level
|
|
Award provider
|
|
||
|
13.
SHORT ESSAYS
Please note that your answers
should not be more than 250 words for each question. Anything over
this limit will not be considered. Attach additional paper if necessary.
|
|
PERSONAL INFORMATION
|
|
a. Briefly describe your personal background and daily
activities, including interaction with your family members and community.
|
|
|
|
b.
Briefly
describe what you consider to be your strengths and weaknesses
|
|
|
|
ACADEMIC AND PROFESSIONAL
DEVELOPMENT
|
|
c.
Briefly
describe significant factors that have influenced your educational and
professional development. What challenges have you overcome in pursuing your
professional development? Describe the challenges as well as any insights,
perspectives or skills you gained in overcoming them.
|
|
|
|
d.
What
is the topic that you are interested in for your future research? Please
elaborate more on the mentioned topic.
|
|
|
|
SOCIAL ACTIVITY
|
|
e.
Please propose a plan on
how will you share your new skills, knowledge and perceptions with your
colleagues and community.
|
|
|
|
f.
If you
are awarded the grant, how will you apply your newly-acquired skills and
knowledge to develop your country or
region and to improve your performance in your institution?
|
|
|
|
VISION AND LEADERSHIP
|
|
g.
Illustrate the chain of
command in your current institution, which best describe the line of
responsibility between you and your supervisor(s), colleagues and/or your
subordinate.
|
|
|
h.
Please give example(s) on
how you demonstrated your leadership skills on your daily activities, whether
in your current or previous employment, or within the community.
|
|
|
|
i.
If you are awarded the
grant, briefly explain your major concern(s) during your future study and
your plan to overcome these concern(s).
|
|
|
|
j.
Briefly describe your professional goals and how they
are related to major problems in your country or region.
|
|
|
|
14.
REFERENCE SUMMARY
Please provide the data of your
referees. The referees should not have family ties with you. This section
should stay attached with the application form.
|
||||||||||||||
|
a. Title
and Name
|
|
|||||||||||||
|
Institution
|
|
Position
|
|
|||||||||||
|
Telephone
|
|
Email
|
|
|||||||||||
|
How long
have you
known
this referee
|
|
Professional
relationship
to
you
Please check only
one box
|
□ Lecturer or
Professor
□ Employer or Job
Supervisor
□ Research Advisor
□ Other:______________________
|
|||||||||||
|
|
||||||||||||||
|
b. Title
and Name
|
|
|||||||||||||
|
Institution
|
|
Position
|
|
|||||||||||
|
Telephone
|
|
Email
|
|
|||||||||||
|
How long
have you
known
this referee
|
|
Professional
relationship
to
you
Please check only
one box
|
□ Lecturer or
Professor
□ Employer or Job
Supervisor
□ Research Advisor
□ Other:______________________
|
|||||||||||
|
|
||||||||||||||
|
c. Title
and Name
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Institution
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Position
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Telephone
|
|
Email
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How long
have you
known
this referee
|
|
Professional
relationship
to
you
Please check only
one box
|
□ Lecturer or
Professor
□ Employer or Job
Supervisor
□ Research Advisor
□ Other:______________________
|
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By my
signature below, I certify that, to the best of my knowledge and belief, the
information provided in all parts of my
application is accurate and complete. I understand that any false statement or
the withholding of any relevant information may provide grounds for the
withdrawal of any offer of appointment or, if an appointment has been accepted,
for its immediate cancellation or termination. If awarded, I agree to comply with any necessary regulations made by
the USAID Scholarship PRESTASI Program.
Note:
If sees
fit and with your consent, information contains in this application form might
be shared to other scholarships program under the USAID Indonesia (please check Agree). If you
decline (please check Disagree),
your information will not be shared to other scholarship program outside USAID PRESTASI
and this condition will not affect your selection process under USAID PRESTASI.
□ Agree □ Disagree
Name & Signature of applicant
_______________________________________ Date ____________________
CONFIDENTIAL
LETTER OF REFERENCE
1.
Name and the title of Referee :
______________________________________________
2.
Referee’s Institution :
______________________________________________
3. How long have you known the
applicant? :
______________________________________________
4.
In what capacity have you known the
applicant?
□ Teacher or Professor □ Employer or Job Supervisor
□ Teacher or Professor □ Employer or Job Supervisor
□
Research Advisor □
Other professional / academic relation (Please Specify):
_____________________________________________
By checking (√) the columns below, please evaluate the applicant compared to the
other students or employees you have known
during your professional career.
|
Skills
|
Excellent
|
Good
|
Average
|
Below Average
|
|
Leadership
|
□
|
□
|
□
|
□
|
|
Intellectual ability
|
□
|
□
|
□
|
□
|
|
Knowledge
of the field
|
□
|
□
|
□
|
□
|
|
Work
habits
|
□
|
□
|
□
|
□
|
|
Motivation to pursue
graduate study
|
□
|
□
|
□
|
□
|
|
Initiative
|
□
|
□
|
□
|
□
|
|
Adaptability
|
□
|
□
|
□
|
□
|
|
Emotional maturity
|
□
|
□
|
□
|
□
|
|
Professional integrity
|
□
|
□
|
□
|
□
|
|
Social commitment
|
□
|
□
|
□
|
□
|
|
Problem Solving
|
□
|
□
|
□
|
□
|
Please circle the number which indicate
where the applicant would rank among individuals you have supervised
1 2 3
4
Poor
Excellent
|
Q1. Overall, what was your
general impression of the applicant?
|
|
|
|
Q2. How would you describe
the applicant’s management style? How does she/he motivate people?
|
|
|
|
Q3. What are the
applicant’s strengths and weakness?
|
|
|
|
Q4. How would you describe
the applicant’s social commitment to his/her community? Please give an
example.
|
|
|
|
Q5. In your opinion, what
is the financial need of this applicant?
|
|
|
|
Q6. Please give additional
facts or comments that may help evaluate the applicant.
|
|
|
Name of Referee:
_______________________________________________________________________
Signature:
__________________________________Date: _______________________________________
|
GUIDELINES FOR REFEREE
|
|
1.
You can use either English or Bahasa
Indonesia to fill in this reference letter. The letter can be handwritten or
type if possible.
2.
For confidentiality, kindly insert the
letter into an envelope, seal and sign it across the border of the tongue,
before handing it back to the applicant.
3.
Please be informed that the Referee is
allowed to post the reference letter directly to IIEF, with the following address:
USAID Scholarship PRESTASI Program
Menara Imperium Lt. 28, Suite A, Jl. HR
Rasuna Said Kav.1
Jakarta 12980, Indonesia
4.
The Selection Committee should receive
the reference letter no later than March
14, 2014. Late submission will not be considered.
5.
The reference letter should be submitted
in its original form. Submission via fax or email is not permitted.
|
CONFIDENTIAL
LETTER OF REFERENCE
1.
Name and the title of Referee :
______________________________________________
2.
Referee’s Institution :
______________________________________________
3. How long have you known the
applicant? :
______________________________________________
4.
In what capacity have you known the applicant?
□ Teacher or Professor □ Employer or Job Supervisor
□ Teacher or Professor □ Employer or Job Supervisor
□
Research Advisor □
Other professional / academic relation (Please Specify):
_____________________________________________
By checking (√) the columns below, please evaluate the applicant compared to the
other students or employees you have known
during your professional career.
|
Skills
|
Excellent
|
Good
|
Average
|
Below Average
|
|
Leadership
|
□
|
□
|
□
|
□
|
|
Intellectual ability
|
□
|
□
|
□
|
□
|
|
Knowledge
of the field
|
□
|
□
|
□
|
□
|
|
Work
habits
|
□
|
□
|
□
|
□
|
|
Motivation to pursue
graduate study
|
□
|
□
|
□
|
□
|
|
Initiative
|
□
|
□
|
□
|
□
|
|
Adaptability
|
□
|
□
|
□
|
□
|
|
Emotional maturity
|
□
|
□
|
□
|
□
|
|
Professional integrity
|
□
|
□
|
□
|
□
|
|
Social commitment
|
□
|
□
|
□
|
□
|
|
Problem Solving
|
□
|
□
|
□
|
□
|
Please circle the number which indicate
where the applicant would rank among individuals you have supervised
1 2 3
4
Poor
Excellent
|
Q1. Overall, what was your
general impression of the applicant?
|
|
|
|
Q2. How would you describe
the applicant’s management style? How does she/he motivate people?
|
|
|
|
Q3. What are the
applicant’s strengths and weakness?
|
|
|
|
Q4. How would you describe
the applicant’s social commitment to his/her community? Please give an
example.
|
|
|
|
Q5. In your opinion, what
is the financial need of this applicant?
|
|
|
|
Q6. Please give additional
facts or comments that may help evaluate the applicant.
|
|
|
Name of Referee:
_______________________________________________________________________
Signature:
__________________________________Date: _______________________________________
|
GUIDELINES FOR REFEREE
|
|
1.
You can use either English or Bahasa
Indonesia to fill in this reference letter. The letter can be handwritten or
type if possible.
2.
For confidentiality, kindly insert the
letter into an envelope, seal and sign it across the border of the tongue,
before handing it back to the applicant.
3.
Please be informed that the Referee is
allowed to post the reference letter directly to IIEF, with the following
address:
USAID Scholarship PRESTASI Program
Menara Imperium Lt. 28, Suite A, Jl. HR
Rasuna Said Kav.1
Jakarta 12980, Indonesia
4.
The Selection Committee should receive
the reference letter no later than March
14, 2014. Late submission will not be considered.
5.
The reference letter should be submitted
in its original form. Submission via fax or email is not permitted.
|
CONFIDENTIAL
LETTER OF REFERENCE
1.
Name and the title of Referee :
______________________________________________
2.
Referee’s Institution :
______________________________________________
3. How long have you known the
applicant? :
______________________________________________
4.
In what capacity have you known the
applicant?
□ Teacher or Professor □ Employer or Job Supervisor
□ Teacher or Professor □ Employer or Job Supervisor
□
Research Advisor □
Other professional / academic relation (Please Specify):
_____________________________________________
By checking (√) the columns below, please evaluate the applicant compared to the
other students or employees you have known
during your professional career.
|
Skills
|
Excellent
|
Good
|
Average
|
Below Average
|
|
Leadership
|
□
|
□
|
□
|
□
|
|
Intellectual ability
|
□
|
□
|
□
|
□
|
|
Knowledge
of the field
|
□
|
□
|
□
|
□
|
|
Work
habits
|
□
|
□
|
□
|
□
|
|
Motivation to pursue
graduate study
|
□
|
□
|
□
|
□
|
|
Initiative
|
□
|
□
|
□
|
□
|
|
Adaptability
|
□
|
□
|
□
|
□
|
|
Emotional maturity
|
□
|
□
|
□
|
□
|
|
Professional integrity
|
□
|
□
|
□
|
□
|
|
Social commitment
|
□
|
□
|
□
|
□
|
|
Problem Solving
|
□
|
□
|
□
|
□
|
Please circle the number which indicate
where the applicant would rank among individuals you have supervised
1 2 3
4
Poor
Excellent
|
Q1. Overall, what was your
general impression of the applicant?
|
|
|
|
Q2. How would you describe
the applicant’s management style? How does she/he motivate people?
|
|
|
|
Q3. What are the
applicant’s strengths and weakness?
|
|
|
|
Q4. How would you describe
the applicant’s social commitment to his/her community? Please give an
example.
|
|
|
|
Q5. In your opinion, what
is the financial need of this applicant?
|
|
|
|
Q6. Please give additional
facts or comments that may help evaluate the applicant.
|
|
|
Name of Referee:
_______________________________________________________________________
Signature:
__________________________________Date: _______________________________________
|
GUIDELINES FOR REFEREE
|
|
1.
You can use either English or Bahasa
Indonesia to fill in this reference letter. The letter can be handwritten or
type if possible.
2.
For confidentiality, once the reference
letter have been filled in, seal and sign it across the border of the tongue,
before handing it back to the applicant.
3.
Please be informed that the Referee is
allowed to post the reference letter directly to IIEF, with the following address:
USAID Scholarship PRESTASI Program
Menara Imperium Lt. 28, Suite A, Jl. HR
Rasuna Said Kav.1
Jakarta 12980, Indonesia
4.
The Selection Committee should receive
the reference letter no later than March
14, 2014. Late submission will not be considered.
5.
The reference letter should be submitted
in its original form. Submission via fax or email is not permitted.
|
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