REPUBLIK INDONESIA
KEMENTERIAN PERENCANAAN PEMBANGUNAN NASIONALI
BADAN PERENCANAAN PEMBANGUNAN NASIONAL
Nomor : -4~41 /P.01/08/2011 Lamp.
Perihal Pemberitahuan Hasil Sereksi Proposal
bagi caron Peserta Magang Jepang 2011
4-
Agustus 2011
Kepada Yth.
Calon Peserta Magang Jepang 2011
(Sebagaimana Terlampir)
Di
Tempat
Menyusuli surat kami Nomor 2146/P.01/04/2011, tanggal 21 April 2011 tentang Penawaran Beasiswa Program Magang di Jepang 2011, bersama ini kami, tim seleksi Bappenas, menyampaikan hasil seleksi calon-calon peserta Magang Jepang 2011 sebagaimana daftar nama terlampir. Pelaksanaan magang di Jepang akan dilaksanakan mulai Oktober s.d. Desember 2011, sementara waktu, kami masih menempatkan calon peserta dibeberapa universitas yang sesuai dengan bidang studi yang diusulkan oleh calon peserta magang. Kami akan memberitahukan lebih lanjut hasil dari proses penempatan tersebut. Mengingat waktu yang cukup mendesak, kami meminta kepada para calon peserta yang namanya tercantum dalam lampiran, untuk dapat segera memproses dokumen perjalananan ke luar negeri (Surat Setkab, passport dan visa). Passport dan visa selambat-Iambatnya dapat kami terima tanggal 16 September 2011. Selain itu, kami mohon setiap calon peserta dapat menginformasikan nama lengkap sesuai paspor masing-masing kepada Sdr. Wiky, Hp. 081317750888. Atas perhatian dan kerjasama Saudara, kami mengucapkan terima kasih.
Kepala Pusat Pembinaan, ~~~~~n dan elatihan Perencana
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* mana Hidayat, MSc, Ph.D 19620323 198903 1 003
Tembusan Yth: 1. Bapak Sesmen PPN/Sestama Bappenas; 2. Direktur Asia Seed di Jakarta.
Jalan Taman Suropati No.2, Jakarta 10310
Telp. (021) 31936207, 3905650, Fax: (021) 3103705, situs Web: www.bappenas.go.id
Lampiran Surat No. 4S4::r/P.Ol/0B/2011 Kepada Yth.:
1. Rosi Handayani, Dinas Budaya Pariwisata, Pemerintah Provinsi Bangka Belitung; 2. Widyana Perdhani, Biro HUl11as dan TU Pimpinan, Bappenas; 3. Yudi Saptono, Dinas Tata Ruang, Pemerintah Kota Bekasi; 4. Akhmad Syaijari, Dinas Tata Kota, Pemerintah Kota Palembang; 5. Cicilia Novi Hendrawati, Dinas Permukiman & Prasarana Wilayah Kota, Pemerintah Kota Yogyakarta; 6. Herdiana Mutmainah, Direktorat Pelabuhan Perikanan, Kementerian Kelautan dan Perikanan; 7. Fithriyah, Direktorat Kependudukan, Pemberdayaan Perempuan, dan Perlindungan Anak, Bappenas; B. Sri Mulyati, Pusat Pengendalian Pemballgunan Kehutanan Regional, Kementerian Kehutanan; 9. Iwan Mustapa, Bappeda Bone Bolango, Gorontalo; 10. Masarina Flukeria, Direktorat Statistik Harga, Badan Pusat Statistik; 11. Bagus Wahyu Hartono, S.STP, MA, Bappeda Sleman, DIY; 12. Bahtiar Rifai, Pusat Penelitian Ekonomi, LIPI; 13. Kiswatiningsih, Dinas Kebersihan Kota Bekasi, Pemerintah Kota Bekasi; 14. Febriana Djuningsih, Direktorat Pembinaan Usaha Hilir Migas, Kementerian ESDM; 15. Caken Zadrek Karatem, Dinas Kebudayaan dan Pariwisata, Pemerintah Kabupaten Kepulauan Aru; 16. Hidayaturrahmi, Pusat Kajian dan Pendidikan Pelatihan Aparatur, LAN; 17. Yudiantarti Safitri, PKP2 A I LAN;
lB. Syahrani, Dinas Pekerjaan Umum, Kabupaten Tanah Laut;
19. Diena Aziza, Bappeda Kabupaten Lampung Tengah; 20. Firdaus, Dinas Pekerjaan Umum Cipta Karya dan Pengairan, Pemerintah Kabupaten Musi Banyuasin.
FELLOW INFORMATION FORM 2010 - 1
PROFESSIONAL HUMAN RESOURCES DEVELOPMENT PROJECT
III
(PHRDP-III)
FELLOW INFORMATION FORM General Instructions (a) This Form should be typewritten or hand-written in Roman letters. (b) Please..j or ~ the appropriate choice. (c) All data is used/or internal purpose and will be regarded as confidential.
D D
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BAPPENAS Domestic Program BAPPENAS Linkage Master
Linkage Master Fellows please circle your program:
D D D
UI-PPIE
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MOF Domestic Program MOF Linkage Master
ITB-MPWK
BAPPENAS Doctoral Program BAPPENAS: ,IFP - PPP - LERD- INTERNSHIP (please circle the appropriate program) Sabbatical ProgramJlnternship/OJT
Cut &Pastefrom here!
UGM-MEP
UGM-MPKD
D D
MOF Regular Master
D
MOF SHORT COURSE:
UB-MAP
MOF Doctoral Program
Personal Information 1.
Name in full
D D
(Write as appears on your passport in Roman block CAPITALS)
NIP 2.
Male Female
Date and Place of birth (state age as of 1sl October 2010)
19 (Year)
(Day)
(Month)
(Age)
(Place ofBirth)
:....................................................."":
3.
Marital Status
4. a
b
D
Single
Name of Current Institution
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Married Paste your passport photograph taken within 6 months. Write your name and program on the back of the photo.
(Please write in English)
Work Unit (Please write in English)
City:
Province:
(6x 4 cm) (TItle ofPosition) :
5.
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Work Address
City:
Province:
Phone/Fax:
6.
7.
Home Address
City:
E-mail address:
Phone/Fax:
Mobile phone:
Preferred Address for Correspondence
D
Work Address
D
Home Address
FELLOW INFORMATION FORM 2010 - 2
Name:
Academic Information 8.
Educational Background Duration of schooling Name of School / Institution
Location From (mmlyy)
To (mm/yy)
/
/
/
/
/
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Higher Education (Master) Graduate Level
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Higher Education (Doctoral Degree) Graduate Level
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High School Education
Higher Education Diploma Program (if applicable) Higher Education (St) Undergraduate Level
Please fill-in (if applicable): GPA Undergraduate Program (Sl): _ _ _ _ __
GPA Master Program (82)
GPA Doctoral Program (83)
TPA 8coreNear taken
9.
Language Skills
Language Proficiency
ENGliSH Good
Reading
Writing
Speaking
TOEFLIIELTS Score:
Exam date (ddlmmlyy): ........ .
FELLOW INFORMATION FORM 2010 - 3
Name:
!O. Professional Background (please write in English) Please jill-in full-time positions held.
(Current or most recent one jirst.)
Employer Address
Telephone
Title of your Position Type of Work Period of Employment
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to
Month/Year
years
Month/Year
Employer Address
Telephone
Title of your Position Type of Work Period of Employment
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to
Month/Year
years
Month/Year
Employer Address
Telephone
Title of your Position Type of Work Period of Employment
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to
Month/Year
11.
/ Month/Year
Person to be notified in applicant's home country, in case of emergency.
Name in full: Address (with telephone number and/or e-mail address):
Occupation: Relationship with Fellow:
I declare that all the statements made herein are true and correct.
Date:
Signature: Name:
years
FELLOW INFORMATION FORM 2010 - 4
Name:
Special Awards, Publications, Professional WorklResearch Activities (Please state below any awards, scholarship you have received, the name ofthe awarder and when. Also briefly describe the field ofstudy you specialized in the past. Please list the professional workJresearch activities that you have conducted and lor academic papers that have been published in journals or any other publications.)
