REGIONAL CENTRE FOR QUALITY IMPROVEMENT FOR TEACHERS AND. —= SOUTHEAST ASIAN MINISTERS OF EDUCATION ORGANIZATION (SEAMEO) = EDUCATION PERSONNEL (QITEP) IN LANGUAGE (SEAQIL) ® Jalan Gardu, Srengseng Sawah, Jagakarsa, Jakarta Selatan 12640, Indonesia | Telp: +62 (021) 7888 4160 | Fax: +62 (021) 7888 4073 LETTER OF DECLARATION I, the undersigned, name :Agi Julianto Martuah Purba nationality : Indonesian institution : SMP Swasta Methodist Tanjung Morawa language specialty —: English 1. agree to fully participate in the Online Training on Teachers’ Competence Improvement from 3 August—30 October 2020 using Altissia learning platform; 2. agree to fulfil the following rules: 2. have a computer/laptop/computer tablet/smartphone, earphone/headphone, etc. with a steady internet connection to facilitate learning . fill out the learning needs analysis questionnaire with my current situation take the placement test and accept any results obtained through the test . follow a minimum of 64 learning hours during the training period take the final test and accept any results obtained through the test fill out the evaluation questionnaire | accept SEAMEO QITEP in Language and Altissia's decision regarding the completion of the training; and empang 3. will conform to the aforementioned rules and agree to take the consequence of losing the opportunity to receive scholarship from SEAMEO QITEP in language should I fail to obey the rules. T hereby declare that the statement is true and correct to the best of my knowledge and belief. Tanjung Morawa, July 24" 2020 Agi Julianto Martuah Purba Note: 1. ‘Scan and save the signed document in POF format (max. 10 MB) 2. Save the document name with the format: STATEMENT LETTER_[ENG/FRA/GER]_ [COUNTRY [YOUR NAME] @wenceaenenseas E) noodteinoagon GQ arerhiannage (@) atestninge (arene