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Tawaran Program SAME Tahun 2017 FORM SAME B

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DIRECTORATE OF CAREER AND COMPETENCY OF HUMAN RESOURCES DIRECTORATE GENERAL OF RESOURCES OF SCIENCE, TECHNOLOGY AND

HIGHER EDUCATION

MINISTRY OF RESEARCH, TECHNOLOGY AND HIGHER EDUCATION

FORM SAME-B

A. PERSON IN CHARGE 1. Full name (capital letters)

: ... ...

(Last name)

... (First name)

2. Gender :  Male  Female

6. Host Institution :

University : ...

(if available)

NIDN : ... ....

Karpeg. ... ...

(if available)

8. Rank (Golongan) : ...

B. INVITEE

1. Name :

2. Institution :

3. Expertise :

Verified by Rector Date : ... Signature of Person in Charge

(2)

... ..

NIP. ...

... ...

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