(This form is to be completed by applicant's direct supervisor who has the authority to |
4, release/confirm the applicant's participation to join the program)
Please note that your signature on this form signifies your agreement to the following:
* to release the applicant from work duties while he/she attend online briefing. This
briefing is full-time and compulsory.
to release the applicant from work duties while he/she attends short course program in
| Australia. This training is full-time and compulsory,
Name of Organisation SMKNAPADANG sail
Name of Authorised Supervisor | DELFAUZULS.PAMPd 4
Position title of Authorised Supervisor PRINCIPAL 5
|_Name of Applicant
HENDRIILYAS
Position title of Applicant TEACHER
Applicant's Level of Date commenced MARCH 2000
Position in
organisation structure |
(eg. Echelon and rank)
How long have you known the applicant and in | 3 YEARS
\ what capacity?
ne - —=-
| Please make any additional comments about | Hendri iyas isan efficient individual and is
| the applicant's potential and personal qualities | committed towards his education and
| which you feel would be helpful to the Short | professional development growth. thold him in |
Course Selection Team. (Additional the highest esteem and highly recommend
pages/documents are accepted) the fellowship award. His combination of
determination and hard work make him an
ideal candidate
Authorised Supervisor signature*
‘On behalf of the organisation, |, the undersigned, agree to be bound to the above
and strategies
| Full Name DELFAUZUL,S.Pd,M.Pd
| Email arismantotelez@gmail.com
oa —\easeuies
| Mobile | +62 813-6341-6516
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