(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 Dipindai dengan CamScanner