FRIENDSHIP Program Outline (March of 2021 to February of 2023) Pre-Institute Orientation and Conversation – Commences March 2021 Online Residential Sessions – Fellow must be present at all program sessions Year 1 (six days: 2 days synchronous - 3 days asynchronous/assignment - 1 day final evaluation/presentation) Dates : Must Zoom meeting present by Monday, March 29, 2021 1st session – Monday, March 29, 2021 (08.00 a.m.) Final session – Friday, May 7, 2021 (03.00 p.m.) Location: Online meeting via Zoom Year 2 (six days – every day) Date : February of 2022 (dates tbd) Location: R. Studio, Gd. Radioputro Lt. 6 FK-KMK UGM Jl Farmako, Sekip, Yogyakarta, Indonesia Online Distance Learning Sessions Year 1 (Ten months) Year 2 (Ten months) FELLOWSHIP ACCEPTANCE STATEMENT (choose one) v I accept my position at the FRIENDSHIP (FAIMER Regional Institute of Indonesia for Educational Development and Leadership) 2021: I agree to follow the schedule of FRIENDSHIP Residential Program (synchronous-asynchronous/assignment-evaluation/presentation) and online attending on time (at 08.00 a.m.) to all synchronous and final evaluation sessions from the date of March 29 until May 7, 2021. I am able to complete the education innovation project and Institute assignment during the intersession. I commit to attend the February 2022 session. I understand I am responsible to pay the tuition fee balance of Rp16.000.000 (terms and condition applied). I decline my position at the FRIENDSHIP (FAIMER Regional Institute of Indonesia for Educational Development and Leadership) 2021. Please explain: _______________________________________________________________ _______________________________________________________________ Print Name: Loo Hariyanto First Name Raharjo Last Name _____________________________________ Signature Date7 Februari 2021 Contact Information (Please print or type) Given Name: Hariyanto Raharjo Family name or Surname: Loo Social Security Number or Identification Number: Degree (s): S2 (Magister) Academic Title: dr. , MSi. Administrative Title: Ketua Program Studi Institute: Universitas Wijaya Kusuma Surabaya Home Address: Pecindilan IV/34 Surabaya Country: Indonesia Email: [email protected] Fax: Primary Phone: 08165428178 Alternate Phone: Skype ID: live:542484286640a4e7 Emergency Contact Name: Go Nani Prayogo Relationship: Wife Address: Pecindilan IV Nomor 34 Surabaya Email: Phone:08819429598 CHECKLIST: All of the following items need to be completed, complied and sent together via email to: [email protected] Biosketch and Photo: v I have attached a paragraph about myself. v I have attached a photo in jpeg format. Email and Skype Address: v I created a new Gmail account for FRIENDSHIP Fellowship v I created a Skype account/ I already had a Skype ID Acceptance Statement: v I have signed and either accepted or declined the FRIENDSHIP Fellowship Contact Information Sheet: v v I have completed my current contact information v I have completed the emergency contact information I have sent requirements on faimer.fluidreview.com Requirements Program Fee The FRIENDSHIP Program Fee is Rp4.000.000,00/participant/semester (the program is to be completed in 4 (four) semesters). But due to pandemic of Covid-19 where all programs will be conducted via online, we apply 50% fee reduction of Rp2.000.000,00/participant for Semester 1 The fee covers: Residential Sessions Instructional materials and books (soft files) Individual project advisor for education project and papers On-line Distance Learning Sessions FRIENDSHIP Certificate in Fellow of FAIMER Regional Institute of Indonesia (FFRII) Electronic library access for two years Bimonthly Conference calls Individual advisor for educational project and papers Curriculum and Other Materials Pre-reading and other course materials will be available and sent to you via e-mail in March 2021. The two years FRIENDSHIP program includes four sessions – two residential (via online and on site in Yogyakarta, Indonesia) and two distance learning. After Session 1 of the Residential Program, Fellows must conduct their projects and participate in Mentoring and Learning (ML Web) – Session 2. Fellows come to Yogyakarta, Indonesia for Session 3 at the end of the first year for advance leadership, management and education issues, and to connect with the new 2022 Fellows. In Session 4, Year 2 Fellows complete the FRIENDSHIP Distance Learning Certificate and Year 2 project progress reports.
