SN:2019-31449

TaiwanICDF International Higher Education Scholarship Programs

2019 SCHOLARSHIP APPLICATION FORM
NOTE: Please fill in this form online at http://web.icdf.org.tw/ICDF_TSP/WelcomeStart.aspx
Incomplete applications and/or applications received after the closing date will not be considered.

Applying for: National Taipei University of Nursing and Health Sciences (NTUNHS) (University)

International Nursing Master of Science Program (Program)

Degree: Master

SECTION I: PERSONAL DETAILS

Name AZHAR ZULKARNAEN ALAMSYAH

Given Name Middle Name Surname

Nationality:Indonesia
Date of Birth(dd-mm-yyyy):04-09-1991 Age:28
Gender:Male Marital Status:Single

Contact Number:62 -+6285720000747

Permanent Address:JL. MURAI NO.41D CIMAHPAR ENDAH 2 SUKABUMI
E-mail Address:alamsyah_azhar@yahoo.com E-mail Address(2):

Twitter: Line:
Facebook:Azhar Zulkarnaen
Others:

SECTION II: EDUCATIONAL BACKGROUND (the highest diploma)

Institution Attended:POLITEKNIK KESEHATAN KEMENTERIAN
KESEHATAN BANDUNG Dates of Attendance (mm-yyyy):From 09-2010 To 09-2013

Course of Study:NURSING
Certificate/Diploma Obtained:DIPLOMA
Institution Attended(2):SEKOLAH TINGGI ILMU KESEHATAN
RAJAWALI Dates of Attendance (mm-yyyy):From 09-2017 To 09-2018

Course of Study:NURSING
Certificate/Diploma Obtained:PROFESI NERS
Have you previously been a recipient of the Taiwan Scholarship?
□Yes, total 　　year(s) ■No

SECTION III: WORK EXPERIENCE (if any)

Name of Previous Company:
Job Position: Dates of Employment (mm-yyyy):
Type Of Organization: From To
Work Content:
Name of Previous Company(2):
Job Position: Dates of Employment (mm-yyyy):
Type Of Organization: From To
Work Content:

SECTION IV: CONTACT PERSON (in case of emergency)

Name:SAKTI ALAMSYAH Relationship:FATHER
Tel:62 -+628158942076 Email:saktialamsyah1958@gmail.com
Address:JL. MURAI NO.41D CIMAHPAR ENDAH 2 SUKABUMI

SECTION V: DESCRIBE SPECIFICALLY HOW YOUR PROPOSED STUDY WILL CONTRIBUTE TO

YOUR CURRENT JOB, OR FUTURE JOB OF YOUR HOME COUNTRY. (Maximum 300 words)
My name is Azhar Zulkarnaen Alamsyah I am 27 years old. I am graduated on Nursing Department Degree (S1) program on
2018, . In this time I have been working at Muhammadiyah University of Sukabumi as an lecture assistant. My major of study is
Medical Surgery, by this major I want to know about the surgery theoretical and practical. I am really interested study about
medical surgery because, in this time have many developing about medical surgery. My vision for the next two years after my
study I will develop about the teaching material at Nursing Department in my university where I am working at the moment but I
am really sure many students will be interested to learn it.
My hobbies are hiking, touring, cycling and swimming. That is my routinity activity in my life until now. I like this activity because
its make me healthy and can eliminate boredom.
My plan if I get accepted and get a chance to study about medical surgery at National Taipei University of Nursing and Health
Science (NTUNHS), I will study and do my best. At my leisure time, I will take an advantage to get better understand the culture
by exploring other areas which are still reachable, due to my sense of curiosity.
That is one of my reason to take medical surgery and also want to know the international perspective medical surgery. I
choose National Taipei University of Nursing and Health Science (NTUNHS) for my study because NTUNHS is one of the
biggest and reputable university, and also many students from Indonesia that study at NTUNHS.
In the Master Program in NTUNHS, I will study hard both of study and do the research about Medical Surgery. And also I want
to get something new about medical surgery that can be implemented when back to Indonesia and also teach my students at
Muhammadiyah University of Sukabumi.

I hereby certify that the information given above is correct, complete and true; and agree that any misrepresentation may render me liable to
disqualification even if accepted. I hereby grant the TaiwanICDF permission to share information contained in my Application Form with relevant
authorities.

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(Signature of Applicant) (Date)