2021 GLOBAL KOREA SCHOLARSHIP Application

Checklist
REGISTRATION NUMBER

Institution Receiving Application (접수기관) :

Person in Charge (확인자) :
Signature (서명) :

1) Name of Applicant : (FITRAH) (MUHAMMAD NUR)

2) Country : INDONESIA

3) Desired Program: ☒ Bachelor’s Degree ☐ Associate Degree

□ Checklist (Submission of Documents) Please check (√) in the appropriate box

Officially
Original 3 Photocopied
Notarized
Document Documents
Required Documents Translation
Ye
No Yes No Yes No
s
Application (Form 1) N/A
Personal Statement (Form 2) N/A
Study Plan (Form 3) N/A
TWO Letters of Recommendation (Form 4) N/A
GKS Applicant Agreement (Form 5) N/A
Personal Medical Assessment (Form 6) N/A
Certificate of High school graduation (or expected graduation
certificate) Original or Certified Copies
High school Grade Transcripts Original or Certified Copies
Certificate of Citizenship Documents (Both Applicant’s & Parents’)
Awards and other certificates (Optional)
Certificate of Korean or English Proficiency C. of Valid TOPIK - - N/A - -
(If applicable) C. of Valid English
- - N/A - -
Proficiency
Proof of Korean War Veteran’s Descendant
- - - - - -
*ONLY for descendants of Korean War Veterans
Proof of Overseas Korean Document /
Proof of Korean Adoptee Document - - - - - -
* ONLY for overseas Korean or Korean adoptees
Proof of Korean Citizenship Renunciation Document
- - - - - -
* ONLY for previous Korean citizenship holders

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FORM 1. 2021 Global Korea Scholarship Application
Please check (☒) the following. Click the box to check or uncheck.

1. Application Track 전형 유형
☒ Embassy 공관 전형 ☐ University Track 대학 전형
2. Type of Application 지원 유형
☒ General 일반 ☐ Overseas Koreans 재외동포
3. Desired Division(Field of Study) 희망계열
☒ Liberal Arts and Social Science 인문사회계열
☐ Science, Technology and Engineering 자연공학계열
☐ Arts and Sports 예체능계열
4. Program to Apply 지원과정
☒ Bachelor’s Degree 학사과정 ☐ Associate Degree 전문학사과정
Please complete the form below. It must be typed in English ONLY.

Surname 성 Given Name 이름 Gender 성별

Full Name
성명 Fitrah Muhammad Nur
☒ Male
☐ Female Photo
*Please write your full name as indicated on your passport or official documents
Date of Birth 생년월일 Size: 3cm x 4cm
2001/12/16 Age 나이 18
(YYYY/MM/DD)
Country 국가 Indonesia Citizenship 국적 Indonesian
Jelarai Raya Street Perum Korpri Blok P7 NO.126, Tanjung selor, North Kalimantan, indonesia.
Contact Information
연락처 +6285156442462
*Must be applicant’s [email protected]
Location (City, Country)
School Name 학교명 High school 10 Samarinda Samarinda, Indonesia
소재국가/도시
High School
출신 학교 Phone 전화 (0541) 6223267 Fax 팩스 (0541) 261829
Mailing Address 주소 [email protected]
English Proficiency Type Score
Language Abilities TOPIK Level
☐1 ☐2 ☐3 ☐4 ☐5 ☐6 Test Scores - -
어학능력 한국어능력시험성적
영어공인성적
Awards Frist Runner up of NSDC 2019 (National School Debating Championship)
(If available)
Choice of University &
Division(Field of Study)
Major University 대학 Department 학과 Major 세부전공
계열
지원신청대학
Liberal Arts & Social Div. of International
Choice 1 Korea University Internasional studies
Science Studies
Embassy Liberal Arts & Social
Choice 2 Hanyang university International Studies Internasional studies
Track Science
Busan Universitu of Liberal Arts & Social Div. of International International Trade
Choice 3
Foreign Studies Science Studies Management
University Track - - - -
※ Attention! Please refer to III. AVAILABLE UNIVERSITIES AND FIELDS OF STUDY in the application guidelines.
 Embassy Track applicants must choose THREE different universities and majors.
(For choice 1 and 2, you may choose universities among Type A & B. For Choice 3, you MUST choose a university from Type B)
 University Track applicants must choose ONE university and major.

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 Period 기간 School / Institution 학교명 Country 소재국

Recently 2008 – 2014 Elementary School 1 Tanjung Selor Indonesia

attended 2014 – 2017 Middle School 1 Tanjung Selor Indonesia
school
학력 2017 – 2020 High School 10 Samarinda Indonesia

Cumulative
High Year Score Percentil
1st year 2nd year 3rd year 4th year 5th year GPA (CGPA)
School e 환산점수
평균평점
Grades* Semest
(ONLY for er 1 2 3 1 2 3 1 2 3 1 2 3 1 2 3
terms or
semesters Grad 85.4 86.9 84.9 87.7 84.7 88.7
completed) / / / / / / / / / 85.5 - / 100
es /100 /100 /100 /100 /100 /100
성적
(이수
학기만) Rank / / / / / / / / / / / / / / / / - / 100

*If needed, you may add additional columns to the term or semester section. You can write either the CGPA or Score Percentile
Name Position Organization Phone Email
Arthamrin131291@gmail.
Abdul Rais Thamrin,S.Pd Teacher School 081334461305 com
List of Recommender
추천인 명단 [email protected]
Ismi Purnama Sari,S.Pd Teacher School 082251825114 om
- - - - -

Previous Visits to Period Purpose of Stay City or Region Affiliated Organization

Korea - - - -
과거 한국 거주 또는
체류 사실 - - - -

Previously Received Grant Amount 지원금액

Sponsor 지원기관 Period 수혜기간
Scholarship Awards (USD/year)
from Korean - -/- -
institutions
장학금 수혜 - -/- -

THE ANSWERS I HAVE GIVEN ABOVE ARE TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE. IF
MY ANSWERS CONTAIN ANY KIND OF FALSEHOOD, I WILL TAKE ANY LEGAL RESPONSIBILITY.

년(2020) 월(09) 일(30)

Muhammad Nur Fitrah (signature)

* Refer to III. AVAILABLE UNIVERSITIES AND FIELDS OF STUDY when choosing universities.
* Refer to Appendix A for the grade conversion table.
FORM 2. PERSONAL STATEMENT
Instructions: Please type in Korean or in English. The essay must be single spaced within TWO page, with
the font Times New Roman, size 11. (*11 points) The essay should include the following things. Please
remove the instructions after reading it.

Albert Einstein once said Wisdom is not a product of schooling but of the lifelong attempt to acquire it,
and I do agree with it, the only way we can have the best version of ourselves is by learning the experience
itself. that why I go to boarding school and live independent in dorm, I join to 4 major organizations, organize
different events, join community service and active on extracurricular activity, then I participate in different

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English competition, to get achievements and developed my English skills. but I don’t forget to balance it on
learning academic, that made me still get to the top best academic performance in my school.
I have a big dream, I want to see more of the world and learn from it, from somebody how never go
outside of his homeland, I am curios and passionate with what the eye can see in other country, what we can
learn from other country for the benefit of our own homeland, because I do believe weakness of certain country,
it could be a strength in another country, that why I really interested to study abroad and learn in international
studies. every big dream like this has long path to go, and I believe this scholarship is one of the major step to
get closer to it. Why? It’s because the scholarship provides a big access to multi-cultural environment, with the
best university on the subject, with advance education and facility and don’t forget the beauty of the country
like the nature, language, culture, and friendly environment.
I grew up in education background, my mom is a teacher and work in different places as single parent
when I was kid. she is the best graduate in her university back then, even though she lives in hardship and poor
condition, she made it to get scholarship and become a teacher. from my mom I learn how hardship is not a
reason to lose hope at education and make me give a highest place on learning. For my education background
my elementary school and middle school I learn it in my home town, but when I was get ready to join high
school I decide to go outside of my province to get more independent and experience like my mom, so I go to
other province separate from my family and live in the dorm. My mom is fully support on my decision and
work hard for the money of my school, and I work hard for the selection process. And finally I get to the one of
the prestigious boarding school, in there my life really changes because the school is full of competition on
academic performance, with full of social struggle in dorm, we required to adapt such a difficult condition.
High school is the place that I developed so much, on that 3 years I join student council, Islamic
organization, English club and green generation, in student council I organized a certain event like independent
day, human right day, school anniversary, international weeks etc. In Islamic organization I do community
service to help orphan and the poor, collect donations for those affected by the disaster, give food to the one
who need, and many more. English club and English debate (as extracellular activity) is where my love to
English start, it is the place to build connection and network with many of people, in there I meet different
people with a great talent on English. The great things about it is, it makes me push myself to become better on
English and join different competition. For Green generation I learn to respect the earth as we do so many
activities like cleaning the environment from plastic and other waste, we take care flower, give food to animal
near our places, and give environment education to other student.
The most important things I learn from organization is positioned, entrusted, safeguarding, and
knowledgeable. Every organization in my opinion have certain positioned that have power, the higher the
positioned the higher the trust. so if we want to have a better positioned in organization, the key is to hold the
value of honesty. And then we need to safeguard the role by doing the best that we can do and doing it only
with knowledge, without the proper knowledge we can’t safeguard the role, the knowledge should be the main
reason to climb the ladder of power. furthermore, the higher the positioned we have the more we should think
for everybody else, because the higher the office the more we become public servant, we shouldn’t think about
how can we hold our positioned but more to how we can bring more benefit to the society.
The event that influence me the most is NSDC 2019 (National school debating championship), the
biggest high school debate competition in Indonesia. To get to NSDC is really hard because we need to go in a
different phase of selection, from school, city, provincial, and finally national levels and I made it become the
representative of the province after a long struggle. But the hard things are when the opponents in national,
mostly big province have the greater resources of learning from national coach compare to small province, that
make them always win and make the competition becoming imbalance. so to win NSDC is really hard for me
and my team. But we made it to go to the final and become the first runner-up despite of the lack of resources.
This is happening only with discipline, hard work, and trust between me and my team. we prove that we
shouldn’t be afraid of what ever struggle we deal with, if we do our best we can reach beyond the limit and do
the impossible. We break the chain of rule of the big province for almost 10 years in NSDC, this is the biggest
experience in my life so far.
For my skills, my mom always influences me to become more independent in basic things like laundry,

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dishes, cooking, and cleaning the house at early age, and now it becoming effortless habit for me. And it
improves better when I live in the dorm, we always been teaching to be discipline from eating, sweeping, and
neat our room. Everything have is own time, and we should respect that. Furthermore, I also learn financial
things because I do many businesses in high school. I learn that is hard to earn money, so I respect every each
of penny in my pocket only for something that I needs not what I wants. Lastly besides that I got second place
in NSDC I also got the champion of NSDC province, first runner up of English debate bunga bangsa, 2 nd runner
up of speech super English competition, I also participate in other debate, storytelling and speech competition
like Mulawarman open debate, English weeks, Words storytelling competition, and SF championship in
regional.
I really hope that we can see each other, so I can show more of the experiences that I had.

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FORM 3. STUDY PLAN
Instructions: Please type in Korean or in English. The essay must be single spaced within TREE page, with the
font Times New Roman, size 11. (*11 points) It is advised that you discuss your academic goals and plans with
your teacher before filling out this form. Please remove the instructions after reading it.

Language Study o Study plans to improve foreign languages(Korean, English, etc) required for taking a
Plan degree course BEFORE and AFTER you come to Korea.
When I was in high school I learn Japanese for one years, but I struggle so much, because of that I switch to
learn Korean. than finally I realize how easy Korean compare to Japan, when Japan have kanji, hiragana and
katakana, Korean only have Hangeul. That make, in terms of simplicity in writing and reading the language,
Korean wins hands down. I optimistic with my passion on learning Korean, because I always curios with China,
Japan and Korean language, it’s because how the language portrays a different aura and character compare to the
rest of the language in the world and because china and japan is so difficult in term of words and alphabet, so I'm
very enthusiastic on studying Korean language even more.

for plan on learning Korean, because I like to read and watch news in YouTube and other source with English
language, now I slowly swift to Korean language news and subtitle. so my main focus of learning is to remember
Hangul and its sound, because I think before I go to Korean, I need to understand the reading first, so I can read
news with Korean, or watch things in Korean subtitle. With this in mind it can make habit of learning language
just so effortless to do. I will learn the Hangeul on app called eggbun: learning Korean fun, it’s a app of learning
Korean base with personal chatbot tutor. It’s really fun for me to learn in this app because it feels like I talking to
real Korean tutor and I have been using it for a while now.

The only best way to learn language in my opinion is by using it frequently, just like how baby learn his first
mother tongue. It’s just how learning language should be, we need to be put on the environment of the language
that we want to learn and actively talking and socialize it with people. because humans will give the meaning of
a word based on what is see, for example if someone says "give the book" we will immediately get the meaning
of it because we can see the body language which indicates it (he pointing the book) and this is something that
only can be learn on the language environment compare to school learning or etc.

This is where I thinks the only way I can developed my Korean language is when I lived in Korean, because with
that I finally can meet native Korean and socialize with them. This is the fundamental thing that I need to do if I
want to master the speaking of Korean, I always have a good popularity on socialize with people, I always open
with stranger, good at opening conversation and talented on makes people feel comfortable. With all the social
skill that I have I confident that I can make a lot of friends and make many interactions with them, this will
improve my ability on speaking Korean drastically.

For English language, I have been learning English since I was a kid until now, I really confident with my
English because I have a lot experience on it, from speaking to writing I always have a good grade on my
English test and my presentation in class. I also been through a lot of competition with English from debate,
speech to storytelling this makes me choose my major only with 100% English because I believe I can give full
of my potential on learning with English, this make me confident with competing on the collage later. Not
forgetting that I will meet a lot of native speakers on English makes me want to developed my English even
more in Korea.

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 Goal of study &
o Goal of study and detailed study plan
Study Plan
For my major in university I choose international studies division, for me international studies are so appealing
because not all countries have it, even in my homeland Indonesia. International studies focus more on social and
cultural issues such as gender studies, global culture, globalization, foreign languages, etc. it makes the careers
of international studies biased towards humanitarian, sociology, culture related aspect. International studies topic
has been my favorite subject since high school because I have learned it in English debate, so I really want to
learn more about it in Korea, I also consider to join English debate community and MUN in Korea because it is
related. My goal of study in I want to achieve a better understanding of the worlds and I want to bring that
understanding back to my homeland and implement it.

Frist year (2022 – 2023)

In my first year of study, I want to give all my effort on studying core courses first, I focuses on adapting myself
on the new environment of study, new friend, and new schedule. I will also attend seminars that have related
topic with my courses. In there I will stay connected with seniors from Indonesia in my major and I know two
persons that is febiola aurora (kgsp 2018) and tineu anggraeni (kgsp 2020), I will ask about courses and book
that I need to prepared for the first year. I will also ask about professor, so I can adapt on the learning later.

Second year (2023 – 2024)

In my second year of study I want to open myself on competition, I want to build more network by joining
different competition in Korean especially English debate as my main focus. Considering that Korea in one of
the candidate of WUDC (World University Debate Championship) and have many organization and competition
for debater. I see an opportunity on my potential to grow. And the good things about it will push me better on
learning international studies even more.

Third year (2024 – 2025)

In my third year I want to focus more on organization and community service, I things it’s the best way for
preparing myself after I graduate, because international studies are more likely to work in NGO, so I want to
creating experience as much as possible. I want to join student council, doing volunteer activities, helping on
student events and manage clubs.

Fourth year (2025 – 2026)

In my last year of my collage, I will be lowering my competition and organizational activities. And focus more
of my test and my academic performances. Because it’s my last years of collage I want to have the best grade on
it, I also will firm up my future plan and seeking different opportunity after I graduate.

Future Plan
o Future plan in Korea or another country after study in Korea
after Study

For now, after I graduate from university I want to go back in my homeland Indonesia, in there I want to apply
internship and job in UN agencies based on Indonesia like FAO, UNDP, and UNICEF. To gain experience on
my field later. I will stay working for 1 – 2 years there, in those years I will also prepared for my next study in
Europe specially London, because London is one of the best place to learning international major. I always want
to learn in London because the best university in the world Is mostly there. I want to get my master there so I can
apply for a job in united nation main place in US, I want to be the first Indonesia that give the most benefit in
united nation. I want to join UNHCR and get a good position there I hope that I can benefit many of people
when I join UNCHR specially people under a war, poverty, asylum seeker. This is always been my main plan
since the beginning

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FORM 5. GKS APPLICANT AGREEMENT

As an applicant for 2021 Global Korea Scholarship for degree program, I agree to abide
by the following;

※ Please read each article, check each box and sign below.

(1) The information I have provided in this application forms are true and accurate and all
documents I submitted to the National Institute for International Education (hereafter
NIIED) are genuine. ☒

(2) I understand that all the documents submitted to NIIED for GKS will not be returned
regardless of the final outcome of the selection process. ☒

(3) I will abide by all the Korean laws and ordinances. ☒

(4) I will respect and uphold the values of the Korean culture and society. ☒

(5) I will fulfill my responsibilities as a GKS scholar to the best of my abilities. ☒

(6) I will not participate in any form of political activities (such as organizing or joining a
political party, attending political meetings, publishing articles and declarations, and
organizing or participating in political demonstrations). ☒

(7) I will maintain financial integrity at a personal level. ☒

(8) I accept NIIED’s decision concerning degree program and the Korean language program.
☒

(9) I understand that once I am selected as a GKS scholar. I am not permitted to change the
university, either for the Korean language program. ☒

(10)I will abide by the academic regulations and requirements of NIIED, Korean language
institution, and university. ☒

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 Date(2001/09/21) Muhammad nur fitrah (Signature)

(continued in the next page)

(11)I understand that if I have any dependents that will accompany me to Korea, I am
responsible for all matters concerning those dependents such as visa issuance and that
NIIED will not provide any extra expenses or support in regards to my dependents. ☒
(12) I give permission to NIIED, the Ministry of Education of Korea, the Ministry of
Foreign Affairs of Korea, the Ministry of Justice of Korea, and affiliated institutions to
use the contact information provided in my application for the purpose of visa issuance,
communication, conducting surveys, and sharing information as needed. I give
authorization for photos and video of me to be taken during GKS orientation and used in
any promotional or educational materials. ☒
(13) I hereby authorize NIIED to verify the information disclosed in this application
form and the documents required by GKS as well as to collect any other information
deemed necessary by GKS to determine my suitability as an applicant from any
institution, organization or individual issuing said information and/or documentation.
This includes but is not limited to contacting recommendation referees or previous
employers. ☒
(14) I hereby understand that all information provided to NIIED will be stored in
secured servers where access will be limited to GKS team and its affiliates. I understand
that all reasonable efforts will be made to protect confidential and sensitive information.
By signing below and submitting my application, I agree to these terms. ☒
(15) I understand that failure to uphold any of the above statements may be grounds
for termination of my scholarship offer. ☒
I confirm that I read all of the above conditions. I also understand that the violation of
any one of the above might result in suspension or cancellation of the scholarship.

Date(2020/09/30) Muhammad nur fitrah (Signature)

FORM 6. PERSONAL MEDICAL ASSESSMENT

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Attention! This form is just a personal medical assessment and applicants do not need to get
comprehensive medical examination for now. However, once applicants are successful in the 2nd round of
selection, in accordance with the requirements of the Korea Immigration Service and Global Korea
Scholarship, applicants must get a comprehensive medical examinations from a licensed physician or a
doctor (including TBPE drug test** etc.) before coming into Korea. All grantees must take another
comprehensive medical check-up (including, TBPE drug test) after coming into Korea in accordance with
the requirements of the Korea Immigration Service and the GKS. If the results show that the applicant is
unfit to study and live overseas, he/she may be disqualified.

Gender ☒ Male ☐ Female HEIGHT 161 cm WEIGHT 64 Kg

QUESTION YES NO IF YES, PLEASE EXPLAIN
Have you ever had an infectious disease that posed a
risk to public health (such as, but not limited to, No
tuberculosis and STDs)?
Do you have allergies? No

Do you have hyper tension? No

Do you have diabetes? No

Do you have any type of Hepatitis? No

Have you ever suffered from or been treated for
depression, anxiety, or any other mental or mood
No
disorder? (If you have received treatment, please
explain and attach an official medical report.)
Have you ever been addicted to alcohol? No
Have you ever abused any narcotic, stimulant,
hallucinogen or other substance, either legally or No
illegally?
Have you been hospitalized in the last two (2) years? No
Have you had any serious injury, ailment or sickness
No
in the last five (5) years?
Do you have any visual or hearing impairment? No

Do you have any physical disabilities? No

Do you have any cognitive/mental disabilities? No

Are you taking any prescribed medication? No

Are you on a special diet? No

Are you pregnant? No

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