ACTIVITY REPORT

INTERNATIONAL EVENT FOR STUDENT

PROGRAM NAME Commented [SWA1]: [Please write the program name in this
section]

ORGANIZING INSTITUTION Commented [SWA2]: [Please write the organizing institution in

this section]

City Name, program duration Commented [SWA3]: [Please write the name of the city where
the event is held followed by the starting date-ending date of the
program DD/MM/YY]

Your Name Your Student ID

BOGOR AGRICULTURAL UNIVERSITY

BOGOR
YEAR
 APPROVAL PAGE
1. Program Name :
2. Destination Country :
3. Student identity
Name/ Student ID :
Cellular phone/ WA number :
E-mail address :
4. Program period : [DD/MM/YY] to [DD/MM/YY]
5. Organizer :
6. Program website :
7. Social media of program :
8. Program category (please thick one from the list below)
□ Exchange program 1 semester/ 2 semester
□ Summer/ Winter Course
□ Seminar/ Symposium/ Conference
□ Service learning program/ international KKN
□ Internship
□ Research
□ Other, please define
9. Number of participating country :
10. Supported budget (IDR)
Registration fee :
Flight ticket cost :
Visa cost :
Travel insurance :
Total proposed budget :
Bogor, DD-MM-YY

Approved by,
Head of Department Student Commented [SWA4]: Can be signed by your Supervisor

Signature Signature

Head of Department Name Student Name

NIP. NIM

Director for International Program Vice Dean for Academic and Student
Affairs

Signature and stamp

Prof. Dr. Ir. Iskandar Z. Siregar, M.For.Sci Vice Dean Name

NIP.19660320 199002 1 001 NIP.

1
 PROGRAM DESCRIPTION

A. Program Name and Theme

Please write the Program Name, the organizing institution (i.e. university,
government institution, professional association, etc.), and particular theme of
the program (if any). You are requested to write the detail contact information
about the organizing committee in this section.
B. Date and Venue

Please write the duration of the program (DD/MM/YY to DD/MM/YY) and

detailed information of the venue (institution name, city, and country name).
C. Participant of the Program

Describe the profile of participants: how many students are participating, from
how many institutions/ universities/ countries/ continent. Please write the name
of all participating countries in this section whenever possible.
D. Rundown/ Program Details
Please write the day-to-day schedule of the program in this section.
E. Program Output
Please describe what did you do during the program, your specific role in the
program, and what was the main benefit for you/ IPB/ and your society after
participating in the program. You are requested to describe the continuity/
sustainability of the program (i.e. what will you do to assure broader impact of
the program).

F. Program Output
Program Category Program Output
Exchange program 1 semester/ 2 Credits obtained from the program
semester
Summer/ Winter Course Credits obtained from the program
Seminar/ Symposium/ Conference  Oral/ poster presentation –
supported by certificate
 Publication in an International
Proceeding (if any)
Service learning program/ Credits obtained from the program
international KKN
Internship Credits obtained from the program
Research Summary of research activity
Other, please define

2
G. Budget Report
Please provide the report for budget supported by IPB through the Directorate
of International Program in this section.
Supported by IPB through the Directorate of International Program
Sub Total
Component USD/ JPY[1] IDR
(IDR)
Registration Fee
Flight[2]
 from JKT
 to JKT
Visa
Travel insurance[3]
Total
Note : [1] Please write the amount in its original currency; [2] Please attach the proof of payment of
particular airlines you used; [3] Please attach the proof of payment of particular travel insurance you
used

Other Funding Support(s)

Please describe in this section if you receive funding supports from other
sources (i.e. scholarship from the organizing committee/ host country, sponsor,
etc.).

Attachment 1. Documentation of the program

Please provide some pictures (with their caption) showing your activity in
the program.

Attachment 2. Proof of payments for component supported by IPB through

the Directorate of International Program

Registration Fee : The payment receipt of registration fee

Visa cost : The payment receipt of visa cost
Flight cost : The payment receipt of flight cost and boarding passes
Travel insurance : The payment receipt of travel insurance
cost

Attachment 3. Certificate of participation

NOTE :
Please fill in an ONLINE REPORT form through
http://bit.ly/report_int_mobility
BEFORE submitting your report to the Directorate of
International Program.