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org

Orange Tulip Scholarship Brazil Application Form Academic year 2014 Personal Data
This information is for use by Nuffic Neso Brazil only

Full Name Address City and State E-mail (direct) Telephone (direct) Birth date Birth place Nationality Sex

DAIANE CARVALHO BATISTA AV DOM EUGENIO SALES, 176, TORRE 3, APT 506, COND. VITA PRAIA RESIDENCE SALVADOR/ BAHIA DAICBATISTA@GMAIL.COM 5571 8780-2997 04/12/1990 SALVADOR/ BAHIA BRAZIL Male Female

Academic Background
Name of the university from which you graduated (or from which you will graduate)

City and State Level of degree obtained Month & year of graduation Grade point average English Skills English exam taken (Please include
a copy of your TOEFL or IELTS diploma, if applicable)

SALVADOR BAHIA Bachelor Master PhD Other DECEMBER, 2011 Excellent TOEFL iBT Good IELTS Average Below Average

Cambridge Certificate

I have not taken an exam yet

Score GRE test result (if applicable) GMAT test result (if applicable)

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Working Experience (Please include your curriculum vitae)

Current or last working experience Company / Organization Job position

Short job description

Other work experience(s)

Financing Your Studies

How do you plan to finance your studies at the Dutch higher education institutions (multiple answers possible)?

My own savings Parents or family Employer

Bank credit Scholarship(s) Other:

For which other scholarships or credits are you applying (multiple answers possible)?

SwB

Bank credit

Other university scholarship (specify) Other:

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About
How did you find out about the Dutch institution as a possible destination university? Internet (please specify which page): Recommendation by friends, family, classmates or professors Recommendation by Holland alumni Nuffic Neso Brazil Fair or events Announcement in media (radio, newspaper, etc; please specify): Other (specify): How did you find out about Nuffic Neso Brazil? Internet (please specify which page): Recommendation by friends, family, classmates or professors Recommendation by Holland alumni Fair or events Announcement in media (radio, newspaper, etc; please specify): Other (specify): How did you find out about the OTS Brazil opportunity? Internet (please specify which page): Recommendation by friends, family, classmates or professors Recommendation by Holland alumni Fair or events Announcement in media (radio, newspaper, etc; please specify): Other (specify):

Why would you qualify for the Orange Tulip Scholarship? (max 500 words attached file)

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Checklist
Please send the following scanned documents to Nuffic Neso Brazil (e-mail) before March 24, 2014 (unless the institution for which you are applying mentions a different deadline on the Orange Tullip Scholarship website). Incomplete forms and package will not be taken into account. Completely filled out OTS Brazil scholarship application form Copy of our acceptance letter (if already received) Proof that you have started the admission procedure at a Dutch institution, e.g. electronic application form (if applicable) A certified copy of your original academic degree (or degrees) in the original language. A translation of your copy academic degree (degrees) into English A certified copy of your transcript (or transcripts) in the original language. A translation of your transcript (or transcripts) into English A certified copy of the report providing the official TOEFL or IELTS score (academic version) A curriculum vitae in English A photocopy of the page (or pages) of your passport that give your name, date of birth, place of birth and passport expiry date Two reference letters in English: one from an official of the faculty from which you obtained you degree and one from your employer or another person in authority, e.g. your Bachelor thesis supervisor. Please note that each Orange Tulip Scholarship participating Dutch higher education institution may require additional documentation, check at www.nesobrazil.org/ots

Place and date

Signature