Juknis Pilot Project

Juknis Pilot Project Juknis Pilot Project

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B. Halaman Pengesahan1. Judul Pilot Project : ..............................................................................................2. Identitas Lembaga PembinaKetua Tim Pilot Project Lembaga Pembinaa. Nama Lembaga : ...........................................................................................b. Nama Lengkap : ...........................................................................................c. Jenis Kelamin : ...........................................................................................d. NIP/NRP : ...........................................................................................e. Jabatan Struktural : ...........................................................................................f. Jabatan Fungsional : ...........................................................................................g. Fakultas/Jurusan/Jenis Ketrampilan : ...................................................................h. Alamat : ...........................................................................................i. Telpon/Faks : ...........................................................................................j. Alamat Rumah : ...........................................................................................k. Telpon/Faks/E-mail : ...........................................................................................Nama Pimpinan Lembaga : ...........................................................................................Alamat : ......................................................................................................................................................................................3. Identitas Lembaga Binaan 1Koordinator Tim Pilot Project Lembaga Binaana. Nama Lembaga : ...........................................................................................b. Nama Lengkap : ...........................................................................................c. Jenis Kelamin : ...........................................................................................d. NIP/NRP : ...........................................................................................e. Jabatan Struktural : ...........................................................................................f. Jabatan Fungsional : ...........................................................................................g. Fakultas/Jurusan/Jenis Ketrampilan : ...................................................................h. Alamat : ...........................................................................................i. Telpon/Faks : ...........................................................................................j. Alamat Rumah : ...........................................................................................k. Telpon/Faks/E-mail : ...........................................................................................Nama Pimpinan Lembaga : ...........................................................................................Alamat : ......................................................................................................................................................................................4. Identitas Lembaga Binaan 2Ketua Tim Pilot Project Lembaga Binaana. Nama Lembaga : ...........................................................................................b. Nama Lengkap : ...........................................................................................c. Jenis Kelamin : ...........................................................................................d. NIP/NRP : ...........................................................................................e. Jabatan Struktural : ...........................................................................................f. Jabatan Fungsional : ...........................................................................................g. Fakultas/Jurusan/Jenis Ketrampilan : ...................................................................h. Alamat : ...........................................................................................i. Telpon/Faks : ...........................................................................................18

j. Alamat Rumah : ...........................................................................................k. Telpon/Faks/E-mail : ...........................................................................................Nama Pimpinan Lembaga : ...........................................................................................Alamat : ......................................................................................................................................................................................5. Anggota TimPilot Project (selain yang telah disebutkan)No Nama Jabatan/Tugas dalam Tim Asal Lembaga123456. PembiayaanJumlah yang diajukan Rp. ..............................Terbilang19

B. Halaman Pengesahan1. Judul <strong>Pilot</strong> <strong>Project</strong> : ..............................................................................................2. Identitas Lembaga PembinaKetua Tim <strong>Pilot</strong> <strong>Project</strong> Lembaga Pembinaa. Nama Lembaga : ...........................................................................................b. Nama Lengkap : ...........................................................................................c. Jenis Kelamin : ...........................................................................................d. NIP/NRP : ...........................................................................................e. Jabatan Struktural : ...........................................................................................f. Jabatan Fungsional : ...........................................................................................g. Fakultas/Jurusan/Jenis Ketrampilan : ...................................................................h. Alamat : ...........................................................................................i. Telpon/Faks : ...........................................................................................j. Alamat Rumah : ...........................................................................................k. Telpon/Faks/E-mail : ...........................................................................................Nama Pimpinan Lembaga : ...........................................................................................Alamat : ......................................................................................................................................................................................3. Identitas Lembaga Binaan 1Koordinator Tim <strong>Pilot</strong> <strong>Project</strong> Lembaga Binaana. Nama Lembaga : ...........................................................................................b. Nama Lengkap : ...........................................................................................c. Jenis Kelamin : ...........................................................................................d. NIP/NRP : ...........................................................................................e. Jabatan Struktural : ...........................................................................................f. Jabatan Fungsional : ...........................................................................................g. Fakultas/Jurusan/Jenis Ketrampilan : ...................................................................h. Alamat : ...........................................................................................i. Telpon/Faks : ...........................................................................................j. Alamat Rumah : ...........................................................................................k. Telpon/Faks/E-mail : ...........................................................................................Nama Pimpinan Lembaga : ...........................................................................................Alamat : ......................................................................................................................................................................................4. Identitas Lembaga Binaan 2Ketua Tim <strong>Pilot</strong> <strong>Project</strong> Lembaga Binaana. Nama Lembaga : ...........................................................................................b. Nama Lengkap : ...........................................................................................c. Jenis Kelamin : ...........................................................................................d. NIP/NRP : ...........................................................................................e. Jabatan Struktural : ...........................................................................................f. Jabatan Fungsional : ...........................................................................................g. Fakultas/Jurusan/Jenis Ketrampilan : ...................................................................h. Alamat : ...........................................................................................i. Telpon/Faks : ...........................................................................................18

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