Format Surat Pernyataan Komitmen dan Integritas (Pendaftar Program Beasiswa S2)

SURAT PERNYATAAN KOMITMEN DAN INTEGRITAS

Yang bertanda tangan di bawah ini, saya

Nama : ______________________________
Tempat, Tanggal Lahir : ______________________________
NIK : ______________________________
NUP/NIDN/NIDK/NITK : ______________________________
Perguruan Tinggi Tujuan : ______________________________
Negara Tujuan : ______________________________
Jenjang Studi : Magister

Menyatakan dengan sesungguhnya bahwa saya:

1. setia kepada Pancasila, Undang-Undang Dasar Negara Republik Indonesia Tahun 1945, dan
Negara Kesatuan Republik Indonesia;
2. mendahulukan kepentingan Bangsa dan Negara Kesatuan Republik Indonesia di atas
kepentingan pribadi;
3. tidak pernah/sedang/akan mendukung atau terlibat dalam gerakan/organisasi/ideologi yang
bertentangan dan/atau berpotensi mengganggu tegaknya ideologi Pancasila, Undang-Undang
Dasar Negara Republik Indonesia Tahun 1945, dan Negara Kesatuan Republik Indonesia;
4. tidak pernah/sedang/akan terlibat dalam aktivitas/tindakan yang melanggar hukum dan norma
sosial masyarakat Indonesia;
5. tidak menggunakan media informasi dan sosial untuk menyampaikan informasi yang belum
terkonfirmasi kebenarannya dan berpotensi menimbulkan konflik di kalangan masyarakat;
6. bersedia mengikuti pendidikan secara penuh waktu (full time) di Perguruan Tinggi tujuan;
7. berkomitmen menyelesaikan studi hingga tuntas dan tepat waktu;
8. berkomitmen melaksanakan ketentuan Beasiswa Indonesia Bangkit;
9. tidak sedang atau telah menempuh studi pada jenjang Magister (S2) baik pada perguruan
tinggi di dalam negeri maupun perguruan tinggi di luar negeri;
10. tidak sedang mendaftar, akan, atau menerima beasiswa dari sumber lain yang berpotensi
double funding selama menjadi penerima Beasiswa Indonesia Bangkit;
11. dokumen dan data pendaftaran adalah akurat dan sesuai aslinya; dan
12. bersedia menerima sanksi hukum yang berlaku dan tidak dapat mendaftar pada seluruh
layanan Kementerian Agama, apabila melakukan pemalsuan dokumen dan data pendaftaran.
Demikian surat pernyataan ini dibuat dengan sebenar-benarnya untuk dapat digunakan
sebagaimana mestinya.
___________ , _______________

Yang Membuat Pernyataan

Materai
Rp 10.000

(________________________)
The form of Commitment and Integrity Statement Letter - Foreign Applicants

COMMITMENT AND INTEGRITY STATEMENT LETTER

The undersigned,
Name : ______________________________
Place, Date of Birth : ______________________________
ID Number : ______________________________
Intended University : ______________________________
Destination Country : ______________________________
Study Level : Master

Hereby declare that:

1. I will respect and honor the values, norms, and culture of the country providing the
scholarship. I will strive to understand and adapt to my new environment with an
open-minded, tolerant, and respectful attitude towards cultural and religious differences;
2. I am determined to make a positive contribution to my community and my country, as well as
the country offering the scholarship. I am committed to applying the knowledge, skills, and
experiences gained during my studies to create meaningful change and positive impact;
3. I promise to uphold academic integrity in all aspects of my studies, refraining from cheating,
plagiarism, or any other violations of academic ethics;
4. I promise to comply with all the rules, regulations, and provisions set by the scholarship
provider. I will fulfill all academic obligations, honestly and promptly report any changes that
may affect my scholarship status, and abide by the campus regulations;
5. I am committed to making education my top priority during my study period.
6. I am committed to complying with the provisions of the Indonesia Bangkit Scholarship.
7. I am committed to maintaining an open-minded and curious attitude towards intercultural
learning experiences. I am ready to learn from diverse backgrounds and perspectives, and I am
willing to share my experiences and knowledge;
8. I am not currently pursuing or have completed a Master's degree (S2) at any domestic or
international institution;
9. I am not applying for, will not accept, or currently receiving scholarships from other sources
that may result in double funding while being a recipient of the Indonesia Bangkit Scholarship;
10. I will actively engage in extracurricular activities, student organizations, and community
initiatives within the campus environment. I understand that involvement in activities outside
of my studies will provide opportunities to develop social skills, leadership abilities, and a
broad network;
11. The registration documents and data provided are accurate and true to the original; and
12. I am willing to accept legal consequences and be disqualified from accessing all services
provided by the Ministry of Religious Affairs if found guilty of falsifying registration documents
and data
I hereby make this statement with utmost truthfulness to be used as deemed necessary
(City) , ____(Date)____

Statement maker

Stamp duty
Rp 10.000

(________________________)