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BRUNEI DARUSSALAM GOVERNMENT SCHOLARSHIPS

FOR FOREIGN STUDENTS TENABLE IN BRUNEI
DARUSSALAM
2016/2017

SESSION

APPLICATION FORM
CODE

PROGRAMME NAME
CIVIL ENGINEER

FIRST CHOICE
SECOND CHOICE

INSTRUCTIONS TO APPLICANTS
1. Each applicant must complete 3 (three) copies of this form to be typed or
written legibly in blue or black ink.
2. The following documents should be submitted with the form:
i.

Three recent passport size photographs.

ii.

Three certified copies of academic qualification.

iii.

Three copies of Applicants Statement of Purpose (Item 6).

iv.

Three certified copies of Birth Certificate and passport.

v.

Three copies of Security Vetting.

vi.

Certified English Translations of supporting documents (i.e.

certificates, testimonials, transcripts) must be submitted for
documents that are not in English.

1. PERSONAL DETAILS (Please use BLOCK Letters)

Name (Please underline surname):
MUHAMMAD IQBAL
Identification No: 1504052301980001

Citizenship: Indonesia

Date of Birth ( dd/mm/yyyy ): 23/01/1998

Country of Birth: Indonesia

Religion: Moslem

Ethnicity: Jambi

Marital Status: Single / Married / Divorced /

Widowed#

Gender: Male / Female#

Postal Address: 36363

Telephone No:_________ - _______ ____________

(country code)

Mobile No:

(area code)

Fax No:

_________ - _______ - ____________

(country code)

(area code)

(tel no.)

(tel no.)

+628 - 5357 - 682018

(country code)

(area code)

(tel no.)

E-mail address (if any):

Iqbal1261@yahoo.com
(Candidates are strongly advised to provide either a fax no. or an email address to facilitate correspondence)
Name of Parent/ Guardian/ Next of Kin#: AMINAH
Relationship: Mother
Occupation / Designation: civil servant
Address: Street Jambi-Muaro Bulian , RT.06, Lopak Aur, Pemayung, Batang Hari, Jambi.
Contact Number/ Email Address:
+6285357682018

2. ACADEMIC EXPERIENCE (Details of Schools Attended and Academic Qualifications)

A. Please state all schools attended from age of 15
Name of School/ Institute
Senior High School 1 Muaro Jambi

From
2013

To
2016

Qualifications Obtained
Full time

B. General Certificate of Education (Ordinary Level or Equivalent)

(Please state subjects that you have passed only)
Year
2015
2015
2015
2015
2015
2015
2015
2015
2015
2015
2015
2015

Subjects
Islamic Religion
Civil Education
Indonesia Laguage
English
Mathematic
Chemistry
Physics
Biologi
History
Art and Culture
Sport
Economy
Foreign Laguage:

2015
2015

Conversation English
Entrepreneurship

Grade
3,84
3,80
3,81
3,73
3,70
3,83
3,86
3,71
3,65
3,84
3,84
3,75

Medium

3,77
3,84

Examination Body
Senior High School 1 Muaro jambi
Senior High School 1 Muaro jambi
Senior High School 1 Muaro jambi
Senior High School 1 Muaro jambi
Senior High School 1 Muaro jambi
Senior High School 1 Muaro jambi
Senior High School 1 Muaro jambi
Senior High School 1 Muaro jambi
Senior High School 1 Muaro jambi
Senior High School 1 Muaro jambi
Senior High School 1 Muaro jambi
Senior High School 1 Muaro jambi
Senior High School 1 Muaro jambi
Senior High School 1 Muaro jambi

C. General Certificate of Education (Advanced Level or Equivalent)

(Please state subjects that you have passed only)

Year
2013
2013
2013
2013

Subjects
Indonesia Laguage
English Laguage
Mathematic
Natural Sciences

Grade
9,18
8,55
8,27
8,97

Medium

Examination Body
Junior High School 7 Batang Hari
Junior High School 7 Batang Hari
Junior High School 7 Batang Hari
Junior High School 7 Batang Hari

D. Other Qualifications (Certificate/ National Certificate/ National Diploma/ Higher

National Diploma/ First Degree)
Qualifications

Name of Institute &

Duration

Country

Date

Classification/

Medium of

Passed

Grade

Instruction

E. Intended Qualification
Name of Programme/ Course

Subjects

Date of Results Expected

3. LANGUAGE PROFICIENCY
Language
English

Written

Reading

Spoken

Others, Please State:

i. .......................

ii. .
1
1: Good

2: Average

2
3: Poor

4. ACADEMIC DISTINCTIONS OR PRIZES RECEIVED

when I attended the physics contest in junior high school I managed to win and received a gift of
a plaque of appreciation

5. PROPOSED FUTURE CAREER

after I graduated and became a major scholar that I will help the development of national or
international for the common good. and I would create a combination that fits between beautiful
and strength, I also want to create a structure that has never been made by anyone, and I really
wanted to create a building that could withstand a disaster in order to help people living in
disaster-prone places

6. APPLICANT STATEMENT OF PURPOSE

In an essay of up to 200 words, describe your plan of study and/ or research you propose to
pursue and relate this to your future career plan. (You may include additional relevant material for
which there was insufficient space on this form).

I have a high interest in the field of civil engineering. My curiosity with different structural
shapes of a different building , plus more in this field not only to design , build, renovate buildings
and infrastructure , but also covers of living environment, makes me even more interest in this
field current and future much needed additional professional staff in this field. Further study is
needed to give birth to a competitive professional who can contribute a maximum of.
With the government program which starts from the national long-term development to
requiring professionals in the field of engineering to help expedite the plan, from what I have
seen so far are still many buildings are just prioritizing one aspect and my desire arises to
combine aspects of beauty and strength into one,and and creating a building that could
withstand a disaster. So for this reason I try to be a part of this program. I'm not just going to
practice skills in the fields or majors that I took, but also I will have the opportunity to learn more
professional in an international setting. Things like how to interact and communicate with
different types of people in a lot of situational context, and how to build relationships for
professional purposes and for international , share knowledge , and create a bond of friendship.
So that's what I have in my mind about why I wanted to participate in this program. I am
confident with my participation in this program will gain more knowledge and valuable
experience, and at the same time sharing information with others for a better future for all. In the
future , I plan to apply my scientific as a professional who is able to advance the development of
both national and international. I made my ambition as one of the stars in the sky. This program
can help me reach the high ambitions of this.

Please tick if additional material enclosed

7. EMPLOYMENT EXPERIENCE (Please attach additional information if required)

Employers Name and Address

Part-Time/

Position Held

Full-Time

Dates
From

To

8. EXTRA CURRICULAR ACTIVITIES AND MEMBERSHIP IN ASSOCIATION

(Please attach additional information if required)
Year

Types of Activities (Sports, Cultural,

Level of Participation (e.g. Club, District,

Community Services etc.)

National, Regional, International etc.)

2014 Pencak Silat

2014 Intra-School Organization
2013 Youth Organizaton HANURA Lopak Aur

Club
Club
District

9. MEMBERSHIP IN ASSOCIATION/ PROFESSIONAL BODIES

(Please attach additional information if required)
Year

Association/ Professional Bodies

2014 Youth Organization HANURA Lopak Aur

2014 Intra-School Organization

Position Held

Member
Member

THESIS RESEARCH

(Y/N)

If you are working on a known thesis topic, attach a 500 words description

Thesis Description enclosed

10. REFERENCES (Originals of reference letters are required to be sent by the applicable referee)
Please give details of two (2) people who can act as referees to support your application. You should
contact them yourself and enclose the references (Form C1) with the application form to the
Scholarship Section, Ministry of Education. Please include their telephone, fax and e-mail addresses
so that we can follow up references if necessary. Applications cannot be considered unless

references are received. Please pass a copy of the Statement by Referee to each referee for him or
her to fill in.
Name of Reference

Job Title &

Telephone & Fax

E-mail

+62-812-74457179

sman1muarojambi@gmail.com

+62-823-7415006

sman1muarojambi@gmail.com

Organisation
Headmaster in Senior
Drs.Helmi

High school 1 Muaro

Jambi
Vice Curriculum and

Refdawati,S.Pd

Teacher in Senior
High School 1 Muaro
Jambi

SECTION 11 14 TO BE COMPLETED BY CANDIDATES WHO INTENDED TO

APPLY FOR HIGHER DEGREE PROGRAMMES ONLY
11. ACADEMIC AWARDS/ SCHOLARSHIP ACHIEVED IF ANY
Academic Awards/ Scholarship

Institution Name

Date Awarded

12. PLEASE LIST DOWN COMPLETED RESEARCH AND PUBLICATIONS IF ANY

Name of Research/ Publications
Reasearch about damage play game for

Date Completed
Mei 7th 2015

students

13. HAVE YOU PREVIOUSLY APPLIED FOR ADMISSION AS A POSTGRADUATE

STUDENT OVERSEAS OR LOCALLY?

Y Yes

If yes, Please State:

N No
i. Year applied:
ii. Name of Programme:
iii. Were you accepted?

iv. Name of Institution: .

14. RESEARCH PROPOSAL

i.

Proposed field of study:

ii.

Topic for Research:

15. DECLARATION
I hereby certify that all the statements made on this application and in the attached
documents are true and correct. I have read all the terms and conditions laid down by the
Brunei Government Scholarship for Foreign Students (ASEAN, OIC, Commonwealth and
others) for which I now apply and I agree to abide by all the conditions of the award. I shall
return to my home country as soon as I complete my scheduled programme and will not
extend my stay without valid reasons.

Date:

Signature:.

C1
BRUNEI DARUSSALAM GOVERNMENT SCHOLARSHIP FOR FOREIGN STUDENTS REFERENCE LETTER

Assessment on the applicants academic ability.

1.

Applicants Name: Muhammad Iqbal

Country: Indonesia

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Courses Applied: ................................................................................................................................................

2.

In what capacity do you know the applicant?

(E.g. Teacher, Supervisor, Principal etc) : Headmaster

3.

How long have you known the applicant? : I know applicant when applicant enter to Senior High School 1
muaro jambi ( 2013) or three years ago

4.

Please evaluate the applicants performance by putting an X in the appropriate spaces below. Extra boxes
are available for you to add, if you wish, up to three other qualities which you may find relevant to the
assessment of the candidate (E.g. All-round ability, ingenuity, accountability, manual dexterity etc.)

Assessment on:

Excellent

Very Good

Good

Average

Below
Average

Academic Record
English Proficiency
Creative Thinking
Research Ability
Industry/ Application
Judgement
Independent
Honesty
Motivation
Self Discipline

5.

Is the applicants proficiency in English Language (oral and written) adequate to meet the standard
required? Please comment.

Although I was never taught the applicant but from that data I have, I found the ability of
applicant in the English language (spoken or written) already meet the standards required in the
English language, of most students I know applicant is one of the students with English language
skills are above average, and the data that I can from discuss English teacher in high school, they
think of the ability to speak English already excel standard required . I highly recommend him in
this program and I strongly believe in the ability English of applicant.
6.

Please give your overall assessment on the applicants academic ability.

From the data I get on the applicants ability in academic I can convey that, the applicant
is one of the students that I think smart in the senior high school 1 Muaro Jambi with velues
above average and all teacher found that the applicant was a smart student in the senior high
school 1 Muaro Jambi. and applicant has always been a contingent in various competitions. I
recommend applicant to continue studying in Brunei and I strongly believe in the ability of the
applicants academic.

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Referees Name: Drs.Helmi

Designation: Headmaster Senior High School 1 Muaro Jambi
Address:
Date:

Signature:

THANK YOU FOR YOUR ASSISTANCE. YOU MAY ENCLOSE THE COMPLETED REFERENCE
LETTER IN A SEALED ENVELOPE AND ATTACH TO THIS APPLICATION FORM OR YOU MAY
SEND THE COMPLETED FORM TO:

Technical Assistance Division, Ministry of Foreign

Affairs and Trade, Jalan Subok, Bandar Seri Begawan, BD2710, Brunei
Darussalam. Fax No: (673) 2230903. E-mail: scholarship@mfa.gov.bn

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C2
BRUNEI DARUSSALAM GOVERNMENT SCHOLARSHIP FOR FOREIGN STUDENTS REFERENCE LETTER
Assessment on the applicants academic ability.
7.

Applicants Name: Muhammad Iqbal

Country: Indonesia
Courses Applied: ................................................................................................................................................

8.

In what capacity do you know the applicant?

(E.g. Teacher, Supervisor, Principal etc) : teacher

9.

How long have you known the applicant? : I know applicant when applicant enter to Senior High School 1
muaro jambi ( 2013) or three years ago

10. Please evaluate the applicants performance by putting an X in the appropriate spaces below. Extra boxes
are available for you to add, if you wish, up to three other qualities which you may find relevant to the
assessment of the candidate (E.g. All-round ability, ingenuity, accountability, manual dexterity etc.)

Assessment on:

Excellent

Very Good

Good

Average

Below
Average

Academic Record
English Proficiency
Creative Thinking
Research Ability
Industry/ Application
Judgement
Independent
Honesty
Motivation
Self Discipline

11. Is the applicants proficiency in English Language (oral and written) adequate to meet the standard
required? Please comment.

13

In my opinion, the ability of applicant in the English language (spoken or written) already
meet the standards required in the English language, of most students I know he is one of the
students with English language skills are above average, and the opinions that I have heard of
English teacher, applicant already meet the standards in english laguage. So I highly recommend
him in this program and I strongly believe in the ability of English applicant.

12. Please give your overall assessment on the applicants academic ability.

I really know the ability of applicant in the academic field because I had become his
teacher. although only one i can conclude that he was a smart student in academic and got good
grades in school. Not only seen from the values that applicant get but from what I heard from the
all teacher, they stated that the applicant has a level of above average intelegence, another thing
that makes me believe in academic ability applicant that he has always been a contingent in
various competitions. I recommend applicant to continue studying in Brunei and I strongly believe
in academic skills possessed applicant.

Referees Name: Refdawati,S.Pd

Designation: Vice Curriculum and teacher in Senior High School 1 Muaro Jambi
Address:

Date:

Signature:.

THANK YOU FOR YOUR ASSISTANCE. YOU MAY ENCLOSE THE COMPLETED REFERENCE
LETTER IN A SEALED ENVELOPE AND ATTACH TO THIS APPLICATION FORM OR YOU MAY
SEND THE COMPLETED FORM TO:

Technical Assistance Division, Ministry of Foreign

Affairs and Trade, Jalan Subok, Bandar Seri Begawan, BD2710, Brunei
Darussalam. Fax No: (673) 2230903. E-mail: scholarship@mfa.gov.bn

TO BE COMPLETED BY THE NOMINATING GOVERNMENT

(The following endorsement must be completed on the top copy of the application by the Nominating Agency)

14

This candidate is nominated for consideration for an award and the following details are confirmed:

Initials of verifying officer

1.

The underlining of the candidates name in question 1 correctly

identifies his or her formal family name.

2.

Evidence verified concerning date and place of birth and

nationality.

3.

References enclosed from the two (2) persons named in

questions 1, 7 and 9.

4.

Candidates medical certificate attached (if required at this stage)

5.

Copies of the university or college transcript attached to each

application form.

6.

The candidate has sufficient language proficiency to enable

him/her to profit from his/her proposed course of study if given
in:
(a)

English

(b)
7.

The candidate is / is not in Government employment (delete appropriately).

.

16. OFFICIAL DECLARATION (to be completed by the nominating government)

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The

SENIOR HIGH SCHOOL 1 MUARO JAMBI

( Name of Department/ Ministry)

nominates ______________________MUHAMMAD IQBAL________________________ on behalf of

______

INDONESIA____________ for the Brunei Darussalam Government Scholarships Award.

(Country)

__________

_Drs. HELMI_________________
(Name)

_____________________________
(Signature and Ministrys stamp)

___

__________ _HEADMASTER__________ street Jambi-Muara Bulian KM 20 Pijoan Kab.

Muaro Jambi
(Designation)
(Address of Department / Ministry)
__________ - ___________ - _________________
(Ctry Code)
(Area Code) (Office Telephone No.)

__________ - ___________ - __________________

(Ctry Code)
(Area Code)
(Office Fax No.)

PLEASE NOTE:
This application form must be duly completed and endorsed by the Ministry of Foreign Affairs or the
relevant agency responsible for the Brunei Darussalam Government Scholarships in your country. Please
attach relevant supporting documents, which are to be submitted with the form. INCOMPLETE AND/OR
UNENDORSED FORMS WILL NOT BE PROCESSED.

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