APPLICATION FORM FOR CHINESE GOVERNMENT SCHOLARSHIP

Personal Data:

Agency No. 3602

Agency Name Embassy of P.R. China in Indonesia

Photo

Last Name KOTO

Surname ACHMAD BADARUDDIN

Chinese Name

Gender Male

Date of Birth 1988-07-28

Marital Status Single

Nationality Indonesia

Native Language Indonesia language

Passport No. A325132

Country of Birth Indonesia

City of Birth Malang

Religion Moslem

Permanent Contact Tel

Permanent Contact Fax

Permanent Contact E-mail achmad_badaruddin@yahoo.com

Permanent Contact Address SMK Tunas HarapanJl Cempaka Putih Barat 14 Cempaka PutihJakarta PusatDKI Jakarta

Present Contact Tel

Present Contact Fax

Present Contact E-mail achmad_badaruddin@yahoo.com

Present Contact Address SMK Tunas HarapanJl Cempaka Putih Barat 14 Cempaka PutihJakarta PusatDKI Jakarta

Education Background and Employment Record:

Highest Diploma

Institution Universitas Negeri Padang

Years Attended From 2008-07-07 To 2015-03-16

Fields of Study Guidance and Counseling

Certificates Obtained or to Obtain Bachelor of Education with Honours

Other Certificate I

Institution Quantum College

Years Attended From 2007-07-06 To 2008-09-06

Fields of Study Computer Information System_____________________________________________________________________________________________________________________

Serial Number: 653047 Generated: 6 Apr 2016Page 1 of 4

Certificates Obtained or to Obtain One Year Integrated Skill Education

_____________________________________________________________________________________________________________________

Serial Number: 653047 Generated: 6 Apr 2016Page 2 of 4

Other Certificate II

Institution Sekolah Trainer Indonesia

Years Attended

Fields of Study Training For Trainers

Certificates Obtained or to Obtain Non Degree

Current Employment

Employer SMK Tunas Harapan Cempaka Putih

Time Engaged From 2015-08-03 To 2016-04-06

Work Engaged Education Counselor

Posts Held Counseling

Language Proficiency and Proposed Study in China:

Chinese Proficiency Fair

Level of HSK test or other certificates

English Proficiency Good

I can be taught in English yes

Other Language Indonesia

Apply for Master's Degree

Disciplines Education

Majors Information Engineering of Psychology

Preferences of Institution I EAST CHINA NORMAL UNIVERSITY

Preferences of Institution II BEIJING NORMAL UNIVERSITY

Preferences of Institution III TSINGHUA UNIVERSITY

Duration of the Major Study From 2016-09-05 To 2019-09-05

Do You Need Elementary Chinese Study prior to the Major Study yes

Duration of Your Elementary Chinese Study (not included in the length of the major study) From 2016-06-01 To 2016-08-01

Have you ever Studied or Worked in China no

Institution or Employer

Time(from/to)

Contact in China and Family Members:

Guarantor's Name

Tel

E-mail

Fax

Address

_____________________________________________________________________________________________________________________

Serial Number: 653047 Generated: 6 Apr 2016Page 3 of 4

Spouse's Name

Age

Employment

Father's Name

Age

Employment

Mother's Name

Age

Employment

◆ Supporting Documentation Attached(Please Indicate with 'X' in the Bracket.):

□ Two Application Forms.

□ Two Letters of Recommendation.

□ Admission Letter or Admission Notice of Chinese Universities.

□ Transcripts of the Most Advanced Studies(Notarized Photocopy).

□ Diploma of the Most Advanced Studies(Notarized Photocopy):

Bachelor's□ Master's□ Doctor's□ Others□

□ Foreigner Physical Examination Form(Photocopy).

□ Study Plan in China.

□ Articles or Papers Written or Published.

□ Examples of Art(6 color pictures)and Music(1 audio tape)Work(Only for the applicants applying for Fine Arts and Music).

□ Other Attachments(List Needed)：_______________________________________________________________

Note:Each Set of the complete materials should not exceed 20 pages．Please use DIN A4.

Whether the candidates are accepted or not,all the application materials will not be returned.

◆ I Hereby Declare That:

1. All information and supporting documentation provided for this application are complete, true and correct.

2. During my stay in China,I shall abide by the laws and decrees of the Chinese government,and will not participate in any activities

in China which are deemed to be adverse to the social order of China and are inappropriate to the capacity as a student.

3. I will agree to the arrangements of my institution and specialty of study in China made by CSC,and will not apply for any changes

in these two fields without valid reasons.

4. During my study in China,I shall abide the rules and regulations of the host university,and concentrate on my studies and researches,

and follow the teaching programs arranged by the university.

5. I shall go through the procedures of the Annual Review of Chinese Govemment Scholarship Status as required.

6. I shall return to my home country as soon as l complete my scheduled program in China,and will not extend my stay without valid

reasons.

7. If I am judged by the Chinese laws and decrees and the rules and regulations of the university as having violated any of the above,

I will not lodge any appeal against the decision of CSC on suspending,or withdrawing my scholarship,or other penalties.

Signature of the Applicant:_____________________Date:_________(The application is invalid without the applicant's signature)

_____________________________________________________________________________________________________________________

Serial Number: 653047 Generated: 6 Apr 2016Page 4 of 4

April 24, 2014

To Whom It May Concern:

I do not have firsthand knowledge of Achmad Badaruddin as a student but I have corresponded with him and have looked over his academic credentials. Mr. Badaruddin is an energetic and dedicated young man. He appears to be especially passionate about counseling and its practice in Indonesia. His grades are very solid and combined with his enthusiasm and knowledge of English, I think he is a very good candidate for an advanced degree in counseling.

Mr. Badaruddin has told me he is applying to your master’s program in counseling. His application is one that I can and do support enthusiastically. I realize that Mr. Badaruddin may make some mistakes in his English (a second language for him) but I think his conceptualization of what counseling is and how to practice it is excellent. He will only get better with time!

Mr. Badaruddin has read my orientation to counseling book and thus he has a broader knowledge of what counseling is than most international students. Furthermore, Mr. Badaruddin is focused on helping counseling become a more regulated and appreciated profession in Indonesia. He recognizes what counseling is compared to other helping profession. His attention to development, wellness and prevention is something to be admired and respected.

Overall, I recommend Mr. Badaruddin to you as a counseling student. His ability is one that will come through over time. His passion will be contagious. His focus will be one that students in you program will admire and respond to. In short, Mr. Badaruddin is a winner. He will bring honor to all involved and devote himself to learning at the highest level possible. He is a “player” who has much to offer now and the future.

Sincerely,

Samuel T. Gladding, Ph.D.

Chair and Professor of Counseling

Wake Forest University

Study Plan

I have plan to study in East China Normal University (ECNU). Because East China Normal University (ECNU) is a key university under the direct auspices of the Ministry of Education of China. ECNU was ranked among 100 key universities of 211 Project of China and was among 39 national key universities of 985 Project of China. It is a research university with an extensive range of disciplines including education, social sciences, humanities, natural sciences and technologies, and administrative sciences. The University has 19 full time schools consisting of 48 departments with 65 undergraduate programmes, 177 Master’s programmes, 120 doctoral programmes and 14 post-doctoral programmes. Since the 1960s, the University has had over 15,000 international students, both degree students and non-degree learners of Chinese.

This University has unique magister programs. One of all, that program is Information Engineering of Psychology. This major is only one in China that I know. And not yet in Indonesia.

I am interesting in that program. I’m in Second Championship Science Olimpiad in Computer Study of Padang Pariaman District (Indonesia) for two periods. And I have graduated from Guidance and Counseling (Accredited “A”) of State University of Padang (Accredited “B”). I learnt a lot of study Psychology in my undergraduate program. So, basicly, I believe I will succes in this major with my competency and knowledge.

I will study from August 2016 until September 2019. Because this program for 3 years. I am planning to design research for R&D in Information Engineering of Psychology, especially counseling or therapy based on technology development. I will make more specific theme for research after I learn more there.

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