GOVERNMENT OF BRUNEI DARUSSALAM SCHOLARSHIP

FOR FOREIGN STUDENTSTENABLE

INBRUNEI DARUSSALAM

APPLICATION FORM

PROGRAMME NAME

FIRST CHOISE : master of Arts in English language and linguistic

by research

SECOND CHOICE : Master of Arts in English Litterature by research

INSTRUCTIONS TO APPLICANTS
1. Each applicant must complete this form, to be typed or written legibly.
2. The following documents MUST be submitted with the form:
i. Recent passport size photographs.
ii. Certified true copies of academic qualifications and other supporting
documents (i.e. certificates, testimonials, transcripts).
iii. Certified English translations of supporting documents must
besubmitted for documents that are not in English.
iv. Applicant’s Statement of Purpose (Item 6).
v. Certified true copies of Birth Certificate and Passport.
vi. Security Vetting.
 1. PERSONAL DETAILS (Please use BLOCK Letters)

Name (Please underline surname): Sopinabila Br.Karo

Passport No: B9203220 Citizenship: Indonesia

Date of Birth ( dd/mm/yyyy ): 23/03/1992 Country of Birth: Indonesia

Religion: Muslim Ethnicity: Karo

Marital Status: Single Gender: Female

Postal Address: Desa Sei Buluh, Kecamatan Sei Bamban, Serdang Bedagai, North Sumater

Indonesia

Telephone No.:______ - _______ - ____________ Fax No.: ______ - _______ - ____________

(country code) (area code) (tel no.) (country code) (area code) (tel no.)

Mobile No.: _____0822_7527__ - __8796_____ -

____________
E-mail address(country
(if any):
code) (area code) (tel no.)

Apprexnabila@yahoo.com

*
Name of Parent/ Guardian/ Next of Kin :
Win Karo Karo

Relationship: Father

Occupation / Designation: Farmer

_________________________________________________________

Address:

Launjuhar 1, kecamatan Tanah Pinem, Dairi, Indonesia

Contact Number/ Email Address: 0852-6020-8026

_____________________________________________________________________________________
 2. ACADEMIC EXPERIENCE
A. PLEASE STATE ALL SCHOOLS ATTENDED FROM THE AGE OF 15
NAME OF FROM TO QUALIFICATION OBTAINED
SCHOOL/INSTITUTION
SD IMPRES 037158 2001 2006 ELEMENTARY DEGREE
MTs. DAIRI SIDIKALANG 2006 2009 JUNIOR DEGREE
SMK DARUL AMIN 2009 2012 HIGH DEGREE
UIN-SU MEDAN 2012 2016 BACHELOR DEGREE

B. GENERAL CERTIFICATE OF EDUCATION (ORDINARY LEVEL OR

EQUIVALENT)

YEAR SUBJECTS GRADE MEDIUM EXAMINATION BODY

2009 INDONESIAN 8.0 OF 10 INDONESIA MINISTRI OF
LANGUAGE EDUCATION
INDONESIA
2009 ENGLISH 8.0 OF 10 INDONESIA MINISTRI OF
LANGUAGE EDUCATION
INDONESIA
2009 MATHEMATIC 7.5 OF 10 INDONESIA MINISTRI OF
EDUCATION
INDONESIA
2009 NATURAL SCIENCE 8.0 OF 10 INDONESIA MINISTRI OF
EDUCATION
INDONESIA

C. GENERAL CERTIFICATE OF EDUCATION (ADVANCED LEVEL OR

EQUIVALENT)

YEAR SUBJECTS GRADE MEDIUM EXAMINATION BODY

2012 INDONESIAN 8.46 OF INDONESIA MINISTRI OF
LANGUAGE 10 EDUCATION
INDONESIA
2012 ENGLISH 7.74 OF INDONESIA MINISTRI OF
LANGUAGE 10 EDUCATION
INDONESIA
2012 MATHEMATIC 8.06 OF INDONESIA MINISTRI OF
10 EDUCATION
INDONESIA
2012 INFORMATION 8.12 OF INDONESIA MINISTRI OF
TECHNOLOGY 10 EDUCATION
INDONESIA

D. OTHER QUALIFICATION

QUALIFIC NAME OF DURATI DATE CLASSIFICA MEDIUM OF

ATION INSTITUTE & ON PASSED TION/GRA INSTRUCTIO
COUNTRY DE N
BACHELO STATE ISLAMI 4 29 APRIL 3.29 OF 4 INDONESIA
R DEGREE UNIVERSITY OF YEARS 2016
NORTH
SUMATERA (UIN-
SU)

E. INTENDED QUALIFICATION

NAME OF SUBJECTS DATE OF RESULTS EXPECTED

PROGRAMME/COURSE

3. LANGUAGE PROFICIENCY

LANGUAGE WRITTEN READING SPOKEN

ENGLISH 1. 1. 1.
OTHER, PLEASE
STATE
i. Arabic 1 1 1
ii. Malay 1 1 1

1.Good 2. Average 3. Poor

 4. ACADEMIC DISTINCTIONS OR PRIZES RECEIVED

I interested about english language since i was in junior high school, Dairi. One of
regency of north sumatra especially in my village, english language still not at regular poeple.
Only some family or school know it. Lucky for me, i study at one of collage in Dairi, where
their activity usually used english and arabic language, and in high school, i always come into
master of ceremony (MC) in competition of laguage in my school.

Based in this reaseon, without thinking of another prodi, i choose department of

education english language.Where based on my family financial, i choosed study and work,
to free the burden of my parent.

And in the fact, study while work was very difficult for me to devide my time. I
started my day with teached in elementary school, and in the evening, i go to my campus for
study, and in night, i teached the course program for elementary school.

5. PROPOSED FUTURE CAREER

My bachelor study on english teacher training and education has prepared me with a
strong grounding in english and theoretical aspect of teaching which can contribute in
developing my self swiftly to reach my future goal in the master’s program. I have learned
about study and learning, professions of education, teaching english as foreign language I and
II, curriculume and material development, and teaching practice in my bachelor study, of
which i got the highest marks.

For this reason, i have totally provided my self to perform well in my future study, and also
by teaching, I realized that English language is very important for global era. My village was
left behind. I interested to improve especially illuminate for education in my village.

6. APPLICANT’S STATEMENT OF PURPOSE

I am playing for a master’s program in teaching englishat the University of

BruneiDarussalam. I have a high interested in developing capabilities of language curriculum
design assesment, and evaluation and the further developing of English teaching method
related to issue of diversities such a culture, mother tongue and communicative competence
in order to result the most suitable method fitting the learners need and background.

I believe this master’s program can prepare me to assume a specialty in the field of
English teaching especially about theoretical approaches, language analysis, curriculum
design, and intercultural communication in reaching the language learning goal in variety of
contexts.
 In the master’s program, i plan to conduct a research concerning about integrated
practical english teaching method resulted from incorporating various life contexts of the
learners. This idea comes along with my awareness of english teaching method should be
varied between one to another place. So many factors influencing the succesful of learners,
such as culture, experience in learning new language knowledge, family background, and
future goal, thatenglish teaching method used in the classroom to reach the language learning
goal must be varied among the different learners. Simply, this research will raise issue of the
learners diversities in english teaching, then exploring and integrating the diversities to
develop the most suitable pedagogical method and lesson plan.

7. EMPLOYMENT EXPERIENCE

EMPLOYER’S POSITION HELD PART DATES

NAME & ADERES TIME/FULL-
TIME
STANDARD TENTOR PART TIME FROM 2013 TO
ENGLISH COURSE 2014
OF NORTH
SUMATERA
ISLAMIC TEACHER FULL TIME FROM 2014 TO
BOARDING 2016
SCHOOL OF
USMAN SYARIF,
MEDAN
ISLAMIC TEACHER FULL TIME FROM 2016 TO
BOARDING 2017
SCHOOL OF
DARUL ARAFAH,
MEDAN
ISLAMIC TEACHER FULL TIME FROM 2017 UNTIL
BOARDING NOW
SCHOOL OF
MA’RIFATUL
HIKMAH, SERGEI
 8. EXTRA CURRICULAR ACTIVITIES AND MEMBERSHIP IN
ASSOSIATION

YEAR TYPES OF ACTIVITIES (SPORTS, LEVEL OF PARTICIPATION (E.G.

CULTURAL, COMMUNITY CLUB, DISTRICT, NATIONAL,
SERVICE ETC) REGIONAL, INTERNATIONAL
ETC)
2012 STUDENTS’ ORGANIZATION OF THE HEAD OF ORGANIZATION
HIGH DEGREE FOR GIRLS
2013 KAMMI TARBIYAH UIN-SU MEMBER

9. MEMBERSHIP IN ASSOCIATIONS/ PROFFESIONAL BODIES

YEAR ASSOCIATIONS/ PROFFESIONAL BODIES POSITION HELD

10. ACADEMIC AWARDS/SCHOLARSHIP ACHIEVED IF ANY

ACADEMIC INSTITUTION NAME DATE AWARDED

AWARDS/SCHOLARSHIP
 11. REFERENCES (Please give details of two (2) people who can act as referees to
support your application. You should contact them yourself and request them to each
complete a “Reference Letter” Form overleaf (C1 or C2) and submit the reference
letter accordingly.

Applications cannot be considered unless references are received

NAME OF JOB TITTLE AND TELEPHONE & EMAIL ADRESS

REFEREE ORGANIZATION FAX
RUSTAM, MA VIECE DEAN, 0812-6450-034 Utam_p@yahoo.com
ACADEMIC & + 62 61 6615683
INSTITUTION OF
TARBIYAH, UIN-
SU MEDAN
Erwinsyah PRINCIPAL OF 0852-0789-2269 erwinsyahpapua@gmail.com
S.Pd, GR HIGH SCHOOL,
MA’RIFATUL
HIKMAH,
SERDANG
BEDAGAI

12. DECLERATION

I hereby certify that all the statements made on this application and in
the attached documents are true and correct. I have read the general terms
and conditions laid down by the Government of Brunei Darussalam
Scholarship for Foreign Students Scholarship Award for which I now
apply. If awarded, I agree to abide by the terms and conditions of the
award and shall return to my home country as soon as I complete my
scheduled programme and will not extend my stay without valid reasons.

DATE : 25 FEBRUARY 2018 SIGNATURE

SOPINABILA BR.KARO