APPENDIX 1

PROJECT TITLE:

Name of Project Leader Name of the members

NAME OF FACULTY UNIVERSITAS GADJAH MADA 2013

APPENDIX 2 Letter of Intent as Participant of UGM RDSP-FF I, the undersigned below, 1. Name 2. Place, Date of Birth 3. Institution
School

: : :*Faculty/Study

Center/Graduate

School/Vocational

4. Contact Address 5. Telephone and Mobile 6. Role in Activity

: : : Principle Investigator (PI)/ Member

declare my willingness to perform my role as stated in the proposal with the title: 2

................................................................................................................................. ..................................... submitted to UGM RDSP-FF .

Signed in On the date of : Dean of ... Faculty Signed Full Name Declarant, Signed Full Name

: Yogyakarta

APPENDIX 3 Applicants should include the following important points on their Letter of Intent : 1. Name of the collaborating institution and its address 2. Name of the contact person from the collaborating institution and his/ her position 3. Name of the Project Leader who is currently applying support from UGM RDSP-FF 4. Duration, type of support and source provided by the collaborating institution 5. Signature of the contact person from the collaborating institution

SAMPLE ONLY! Letter of Intent as Collaborating Institution of UGM RDSP-FF

This Letter of Intent is made this Thursday day of February 21, 2013 Mr. Ahmad Safrizal, the head of Research and Development Department appointed as representative of Pemerintah Daerah Propinsi Maluku whose principal institution is at Pemerintah Daerah Maluku Jalan Sehat 3 Maluku has agreed to support and develop a project within the scope of UGM Research and Development Support Programme-Funding Facility with the tittle Economic and Livelihood Development of which the Project Leader is Ms. Raisha Firzi, whose principal institution is at Faculty of Economics and Business, Universitas Gadjah Mada, Bulaksumur, Yogyakarta 55281 As per initial evidence of our willingness, this Letter of Intent agrees as the followings: 1. To support the project for the duration of 8 months, from May 1 December 31, 2013. 2. To support the project in terms of funding and office facility with the amount of funding as much as Rp50.000.000,00. 3. To provide an office room in office of Pemerintah Daerah Propinsi Maluku. 4. To provide ... (please specify) Further arrangement of the support provided is available separately in a specific Partnership Agreement between Pemerintah Daerah Provinsi Maluku and Faculty of Economic and Business UGM.

Place, and Date Signed Ahmad Safrizal Head of Research and Development Department Pemerintah Daerah Propinsi Maluku APPENDIX 4 Proposed Budget A. Budget Allocation No Budget Item Contribution to be requested from RDSP-FF Percentage from RDSP-FF total Contribution from other sources 4

grant 1 2 3 4 5 6 7 Salary Commissioned Work Travel Expenses Equipment & Spare Parts Consumables Administrative overhead Others Expenses (please specify) Total

(if any)

B. Budget Breakdown 1. Salary N Item Description o 1 Project Leader 2 Member 1 3 Member 2 Sub Total 2. Commissioned Work N Job Detail o 1 Sub Total 3. Travel Expenses N Item Description o 1 Trip 1 Air fare Accommodati on 2 Trip 2 Air fare Accommodati on Sub Total

Cost per month

Quantity (month)

Amount

Cost per unit

Quantity (Day/ month)

Amount

Cost per unit

Quantity

Period of stay (Day/ night)

Amount

4. Equipment & Spare Parts N Item Description o

Cost per unit

Quantity

Amount 5

1 Sub Total 5. Consumables N Item o 1 Sub Total 6. Administrative overhead N Item o 1 Sub Total 7. Other Expenses N Item o 1 Sub Total C. Budget Allocation No Budget Item Term. Contribution to be requested from RDSP-FF Percentage from RDSP-FF total grant Contribution from other sources (if any)

Cost per unit

Quantity

Amount

Cost per unit

Quantity

Amount

Cost per unit

Quantity

Amount

1 2 3 4 5 6 7

Salary Commissioned Work Travel Expenses Equipment & Spare Parts Consumables Administrative overhead Others Expenses (please specify) Total

APPENDIX 5 Curriculum Vitae A. PERSONAL DETAILS

1. Full Name (with Academic Degree) 2. Place, Date of Birth 3. Office Address 4. Institution 5. Contact Details (telephone, facsimile and e-mail)
B. EDUCATION 1. Doctorate Level Name of University and Place Start year End year Dissertation topic 2. Master Level Name of University and Place Start year End year Thesis topic 3. Bachelor Level Name of University and Place Start year End year Undergraduate thesis topic C. RESEARCH AND/ OR COMMUNITY DEVELOPMENT, TRAINING AND WORKSHOP, AND TECHNICAL ASSISTANCE EXPERIENCES (in the last five years) [Project Title], [Project Type], [Job Title], [Year] [Project Title], [Project Type], [Job Title], [Year] D. Recent Peer-reviewed Publications/ Invited Papers/ Presentations in the last 5 years Peer-reviewed [Author name and publication], [Publication], [Year] [Author name and publication], [Publication], [Year] E. INTERNATIONAL COLLABORATION EXPERIENCES Project Name Start date End date, and Place Name of partner(s) Source of Funding(s) Project Output(s)

Place, and date Signature Full Name