YSEALI Academic Fellowships Application

Incomplete applications will not be considered.

A. Applicants Full Name, exactly as it appears in passport:

Prefix: Ms.

Last Name : Karamasa

First Name : Anawaydicyta

Middle Name : Iv

B. Gender :
Male Female
C. Date of Birth : 2/18/1992

D. Place of Birth : Kendari

E. Country of Birth: Indonesia

F. Citizenship
Primary : Indonesia
Secondary :
(if applicable)

G. Current Country of Residency : Indonesia

H. Medical, Physical, Dietary or other Personal Considerations:

Disability:
-
Please describe any pre-existing medical conditions, including any prescription medication the
candidate may be taking, or any other dietary or personal consideration. This will not affect
candidate selection, but will enable the host institution to make any necessary accommodations.

Nomination Due: Wednesday, December 31, 2014

Questions? Call: (021) 3435-9641; E-mail: YSEALIjkt@state.gov
 YSEALI Academic Fellowships Application

I. Applicant Contact Information:

Jalan Bunga Kamboja No. 32, Kelurahan Lahundape
Address :
City : Kendari
Province : Southeast Sulawesi
Postal Code : 93127
Country : Indonesia
Email : w_heysel@y7mail.com
*if you do not have an active email address, please create one prior to submitting your
application, and indicate it here
Phone : 081372692228

Emergency Contact Phone: 085241862159

Emergency Contact Name and Relationship: Karamasa, Father

*Example: John Doe, Father

J. Academic Major, Institution/University:

-Major : Civil Engineering
-Home Institution : Indonesia
Country Name
-Institution/University : Halu Oleo University

K. Work Experience, including previous positions, titles, institutions, dates of employment

(dd/mm/yyyy), and part/full time position:

From To Title/Institution (Please specify if position is part time)

2012 2012 Flexible Pavement of Diponegoro Street Kab. Konawe, as

assistant of as built drawing drafter, PT. Aneka Laksana
(Part time position)
2012 2012 Rigid Pavement of Monginsidi Street Kab. Konawe, as
assistant of as built drawing drafter, PT. Prima Dwi Utama
(Part time position)
2012 2012 Rigid Pavement of Jenderal Sudirman Street Kab. Konawe,
as assistant of as built drawing drafter, PT. Daya Mulia
Turangga (Part time position)
July 13th, 2013 September 1st, Building Ambaku Box Culvert, in Asera, as assistant of shop
2013 drawing drafter, PT. Suramadu Indonesia (jo)-PT. Cahaya
Agung Perdana Karya (Part time position)
Nomination Due: Wednesday, December 31, 2014
Questions? Call: (021) 3435-9641; E-mail: YSEALIjkt@state.gov
 YSEALI Academic Fellowships Application

August 13th, 2014 August 20th, Research about water quality of Upper course of Kendari
2014 River, as researcher, Environmental Laboratory, University
of Halu Oleo (Part time position)
August 21th, 2014 August 28th, Research about water quality of Lower course of Kendari
2014 River, as researcher, Environmental Laboratory, University
of Halu Oleo(Part time position)
August 28th, 2014 September 5th, Research about water quality of the river near by Kendari
2014 Swiss Bell Hotel, as researcher, Environmental Laboratory,
University of Halu Oleo (Part time position)
September 5th, September 12th, Research about water quality of the river near by Athaya
2014 2014 Hotel, as researcher, Environmental Laboratory, University
of Halu Oleo (Part time position)
September 12th, September 18th, Research about water quality of the river near by
2014 2014 Lasandara Bridge, cattle market region, as researcher,
Environmental Laboratory, University of Halu Oleo (Part
time position)
August 26th, 2014 December 12th, Renovation of DPRD Provinsi Sulawesi Tenggara Hall, as
2014 project supervisor, CV. Rahmat Jaya (Part time position)
August 25th, 2014 November 25th, Building Box Culvert, as project supervisor, Public Work
2014 Department of Kendari City (Full time position)
June 1st, 2014 July 1st, 2014 Coordinator Team of Daily Transportation Survey of
Kendari City, Public Work Department of Kendari City
(Full position)
August 1st, 2014 August 31st, 2014 Flexible Pavement of Wawotobi-Pohara-Kendari, as
assistant of shop drawing drafter, PT. Daya Mulia Turangga
(Part time position)
November 1st, December 1st, Flexible Pavement of Wawotobi-Pohara-Kendari, as
2014 2014 assistant of as built drawing drafter, PT. Daya Mulia
Turangga (Part time position)
February 16th, May 16th, 2015 Planner Team of Green Camping Region of Kendari City,
2015 Public Work Department of Kendari City (Full position)
July 1st, 2014 now Civil engineering staff, Public Work Department of Kendari
City (Full time position)
July 1st, 2013 now Laboran, Environmental Laboratory, Engineering Faculty,
Halu Oleo University (Part time position)
July 7st, 2011 now Owner of Mubarak Multi Preneurs Tour and Travel (Full
time position)

Nomination Due: Wednesday, December 31, 2014

Questions? Call: (021) 3435-9641; E-mail: YSEALIjkt@state.gov
 YSEALI Academic Fellowships Application

L. Volunteer Experiences :

From To Title/Institution

2007 2007 Teenager Charity in Ramadhan, as volunteer of Food

Gathering for Poor People, SMAN 6 Kendari
2008 2008 Teenager Charity in Ramadhan, as volunteer of Food
Gathering for Poor People, SMAN 6 Kendari
2008 2008 Planting 1 tree for each home, as volunteer, SMAN 6
Kendari
June 16th, 2009 August 20th, 2009 Paving Block Road for RT. 07/ RW. 07 Kel. Wua-wua, as
as cost estimator and writer of reporting project, Badan
Keswadayaan Masyarakat Morini
June 16th, 2009 August 20th, 2009 Semi Rigid Pavement RT. 02/ RW. 01 Kel. Wua-wua, as
as cost estimator and writer of reporting project, Badan
Keswadayaan Masyarakat Morini
June 16th, 2009 August 20th, 2009 Building Bridge 4 meters long for RT. 15/ RW. 03 Kel.
Wua-wua, as as cost estimator and writer of reporting
project, Badan Keswadayaan Masyarakat Morini
June 16th, 2009 August 20th, 2009 Building Duicker 4 meters long for RT. 20/ RW. 05 Kel.
Wua-wua, as as cost estimator and writer of reporting
project, Badan Keswadayaan Masyarakat Morini
December 5th, January 5th, 2010 Building drainage system 75 meters long for RT. 01/
2010 RW. 03 Kel. Wua-wua, as cost estimator and writer of
reporting project, Badan Keswadayaan Masyarakat
Morini
December 5th, January 5th, 2010 Home Reparation of Poor People Kel. Wua-wua, as cost
2010 estimator and writer of reporting project, Badan
Keswadayaan Masyarakat
December 5th, January 5th, 2010 Building Posyandu Center for RT. 04/ RW. 04 Kel. Wua-
2010 wua, as cost estimator and writer of reporting project,
Badan Keswadayaan Masyarakat Morini
September October 20th, 2010 Semi Rigid Pavement of RT. 01/ RW. 01 Kel. Wua-wua,
20th, 2010 as cost estimator and writer of reporting project, Badan
Keswadayaan Masyarakat
September October 20th, 2010 Children Reading House for RT. 01/ RW. 03 Kel. Wua-
20th, 2010 wua, as cost estimator and writer of reporting project,
Badan Keswadayaan Masyarakat
2012 2012 Charity for orphan in Ramadhan, coordinator of fund
gathering, LDK Ulul Albaab, Halu Oleo University
2013 2013 Charity for orphan in Ramadhan, coordinator of
publication, LDK Ulul Albaab, Halu Oleo University

Nomination Due: Wednesday, December 31, 2014

Questions? Call: (021) 3435-9641; E-mail: YSEALIjkt@state.gov
 YSEALI Academic Fellowships Application

May 3th, 2012 July 3th, 2012 Building short bridge for Kel. Wua-wua RT.03/RW. 01,
as volunteer of cost estimator and writer of reporting
project, Badan Keswadayaan Masyarakat Morini
May 4th, 2012 July 3th, 2012 Building drainage system 50 meters long for Kel. Wua-
wua RT.03/RW. 03, as volunteer of cost estimator and
writer of reporting project, Badan Keswadayaan
Masyarakat Morini
May 4th, 2012 July 3th, 2012 Building the well for Kel. Wua-wua RT.03/RW. 03, as
volunteer of cost estimator and writer of reporting
project, Badan Keswadayaan Masyarakat Morini
May 4th, 2012 July 3th, 2012 Reconstruction of the road 62 meters long for Kel.
Wua-wua RT.03/RW. 03, as volunteer of cost estimator
and writer of reporting project, Badan Keswadayaan
Masyarakat Morini
May 5th, 2012 July 3th, 2012 Rigid Pavement for Kel. Wua-wua RT.04/RW. 04, as
volunteer of cost estimator and writer of reporting
project, Badan Keswadayaan Masyarakat Morini
May 5th, 2012 July 3th, 2012 Reconstruction of the road 22 meters long for Kel.
Wua-wua RT.03/RW. 05, as volunteer of cost estimator
and writer of reporting project, Badan Keswadayaan
Masyarakat Morini
January 1st, March 24th, 2013 Spectacular Event Gebyar Mahasiswa Muslimah
2013 Sulawesi Tenggara, as Coordinator Team of
Transportation Division, LDK Ulul Albaab, University of
Halu Oleo
October 30th, Desember 20th, Building drainage system 50 meters long for Kel. Wua-
2013 2013 wua RT.03/RW. 03, 2nd spot, as volunteer of cost
estimator and writer of reporting project, Badan
Keswadayaan Masyarakat Morini
November Desember 20th, Building the well and its tower for Kel. Wua-wua
23th, 2013 2013 RT.03/RW. 03, 2nd spot, as volunteer of cost estimator
and writer of reporting project, Badan Keswadayaan
Masyarakat Morini
2013 2013 Training of Programming of OS Windows 7, as
volunteer speaker, LDK Ulul Albaab, Halu Oleo
University
2013 2013 Kendari Flood Rescue, as member of female rescue
team, Division Of Society, Environment and Health, LM
WI Kendari
2013 2013 Healthy Check Up for people, as member of female
rescue team, Division Of Society, Environment and
Health, LM WI Kendari

Nomination Due: Wednesday, December 31, 2014

Questions? Call: (021) 3435-9641; E-mail: YSEALIjkt@state.gov
 YSEALI Academic Fellowships Application

2013 now Volunteer of Instructor of Forum Belajar Ilmiah (FBI) for

English and Design 2D drawing using Auto Cad, LDK Ulul
Albaab, University Of Halu Oleo
2012 now Reciting Al Quran for student, as a teacher, LDK Ulul
Albaab, University Halu Oleo
2014 2014 1 tree 1 student in SD WI Kendari, as a trainer for
student elementary school, Division Of Society,
Environment and Health, LM WI Kendari
January 17th, July 25th, 2014 Building Rumah Muslimah Kendari, as volunteer of
2014 Cost Estimator and Drawing Drafter, LM. WI Kendari
July 13th, 2014 July 13th, 2014 Ramadhan charity for orphan, as coordinator team,
Division Of Society, Environment and Health, LM WI
Kendari
March 15th, March 15th, 2015 Muslimah talk show of Kendari City, as member of
2015 publication, Division Of Society, Environment and
Health, LM WI Kendari
March 28th, March 28th, 2015 Cervix cancer socialization for Kendari Muslimah, as
2015 member of publication, Division Of Society,
Environment and Health, LM WI Kendari
April, 2015 April, 2015 Brimob wifes socialization about health workshop, as
facilitator of workshop, Division Of Society,
Environment and Health, LM WI Kendari
April, 2015 April, 2015 Kambu environmental workshop, as facilitator of
workshop, Division Of Society, Environment and Health,
LM WI Kendari
2014 now Environmental event organizer, as facilitator of
workshop or talk show, Division Of Society,
Environment and Health, LM WI Kendari
2014 now Handling of human corpse for poor people or needed
people, as coordinator of emergency request, Division
Of Society, Environment and Health, LM WI Kendari
April, 2015 April, 2015 Division Of Society, Environment and Health, LM WI
Kendari
February 18th, February 20th, 2015 Building Abu Bakar Mosque in front of First Gate of
2015 Halu Oleo University, as volunteer of cost estimator

M. Year in School (or Semester in School) and Expected Graduation Date, or date degree attained if
already graduated:
4/11/2014

Nomination Due: Wednesday, December 31, 2014

Questions? Call: (021) 3435-9641; E-mail: YSEALIjkt@state.gov
 YSEALI Academic Fellowships Application

N. Memberships in Associations, Clubs, etc., including position type, title, and

Organization name:
*Please include dates (example: Student Government, May 2011 to June 2012)
Member of Society, Environment and Health Division of LM WI Kendari, 2013

O. Previous Experience in the United States:

Have you travelled to the U.S. before?
Yes No
If yes, please fill out the following section

From: Click here to enter a date. To: Click here to enter a date.

Purpose:

Nomination Due: Wednesday, December 31, 2014

Questions? Call: (021) 3435-9641; E-mail: YSEALIjkt@state.gov
 YSEALI Academic Fellowships Application

P. Family Residing in the United States:

Yes No
Do you have close family residing in the U.S.?

If yes, please fill out the following section; if no, please write None.

*Please include city and state (Example: John Doe Chicago, IL)

Q. Evidence of English Fluency:

(Please note if you have taken a language proficiency test, lived abroad, or taken English language
courses. If you have taken any language proficiency test please provide the date it was taken and your
test score if you have taken English language courses please indicate your level of English in the
course.
I have taken english course at Progress English Course of Kendari. My last scoring was 513 for

R. Please check to which institute you are applying (only one may be checked)
Civic engagement
Environment and natural resources management
Entrepreneurship and economic development

S. Personal Statement by Candidate:

Tell us about yourself and your goals including the following: What about your background and/or
interest makes you competitive for this particular institute (please be as specific as possible)? What
will you contribute to the group? How do you expect this experience will affect your future academic
and professional career? How will it affect you personally?

As the fresh graduated I do not have enough experience even I had related job at the past.
America is famous with friendly environmental technology. For instance; green building concept and
regulation about the hall or road construction. So that I hope I can get new insight about it from
YSEALI Academic Fellowship. Having an experience from a developed country like America and ASEAN
countries is one of the most precious experiences which will impact our mind about how to become a
success leader and influential one who considers to keep friendly technology. Even I am still young
people, I believe I will be a leader one day even just in my community. In my community, every month
we almost make a talk show about the environment. I do believe that even it is just a little
contribution to my town, it will impact our next generation with these works. Because it is not
impossible people attending the talk show is a candidate of our town leader who will make the
regulation. At least, they will know what will happen if we do not keep our environment. It is not only
Nomination Due: Wednesday, December 31, 2014
Questions? Call: (021) 3435-9641; E-mail: YSEALIjkt@state.gov
 YSEALI Academic Fellowships Application

fun event but also hard event. Because we will have new burden to spread the insight given to us.
Nevertheless I hope I can be responsible it so that it will not only be a fun trip me but also it will be
my responsibilty. Because the insight is for shared. Better insight is for better future.

Please attach your response, limited to 250 words, and submit along with this completed application
and one letter of recommendation from someone who knows you well, to YSEALIjkt@state.gov.

Nomination Due: Wednesday, December 31, 2014

Questions? Call: (021) 3435-9641; E-mail: YSEALIjkt@state.gov