K.

Paid Work Experience, including full time or part time employment,

or paid internship:
Please include dates of employment, title of the institution and job title. You may enter more than
one

 Dates : 04/14/2016 to 04/17/2016

Title of the institution : Indonesia Climate Change Education, Forum, & Expo 2016 held by
Ministry of Environment & Forestry Indonesia - Indonesia President’s Special Envoy for Climate
Change
Job title : Mentor & Facilitator

 Dates : 09/11/2015 to 09/13/2015

Title of the institution : Youth for Climate Camp 2015 (Indonesia President’s Special Envoy for
Climate Change, JICA, & The Climate Reality Project Indonesia)
Job title : Mentor & Facilitator

 Dates : 06/01/2015 to 07/01/2015

Title of the institution : PT. Indocement Tunggal Prakasa Tbk
Job title : Process Engineer Internship

 Dates : 05/14/2015 to 05/17/2015

Title of the institution : Indonesia Climate Change Education, Forum, & Expo 2015 held by
Ministry of Environment & Forestry Indonesia - Indonesia President’s Special Envoy for Climate
Change
Job title : Mentor & Facilitator

 Dates : 02/01/2015 to 05/01/2015

Title of the institution : Bebas Sampah ID
Job title : Surveyor & Research

 Dates : 09/10/2013 to 05/20/2014

Title of the institution : Student Center ITB
Job title : Tutor in Chemistry

L. Unpaid internship or volunteer experience:

Please include dates of internship or volunteer experience, title of the institution and job title. You
may enter more than one

 Dates : May 1st,2017

Title of the institution : Gerakan 60 Pemuda Peduli Jambi (G60PPJ)
Job title : Member
60 youth as alumni of the selection of Pertukaran Pemuda Antar Negara (PPAN) Jambi
Province conducted an action to clean up Jambi in one day by collecting the rubbish on
the main road & strategic places of Jambi Province. Inviting all of people to take action
together with us and send messages (campaign) about Jambi’s environmental
 condition and how to conserve’s Jambi environmental in good way. We also take
donation that will give to some communities in Jambi that focused to develop
education for local tribe in Jambi (Suku Anak Dalam).

 Dates : 03/14/2016 to 03/17/2016

Title of the institution : Climate Reality Leadership Training - The Climate Reality Project
Job title : Climate Leader (Trained by the Honorable Mr. Al Gore)
Climate Reality Leaders are the climate movement’s front-line agents for change.
They’re working in over 100 countries around the world to educate the public on
climate crisis and build networks that inspire solutions and promote action in their
communities and beyond.

 Dates : 11/20/2015 to 12/12/2015

Title of the institution : Bamboo for Earth - Youth for Climate Change Indonesia & Gerakan
Kerelawanan Internasional (Great)
Bamboo for Earth, the community development in Batu Lonceng village
with the activities are planted 210 seeds of bamboo & trees, workshop
about water conservation, workshop about the advantages of bamboo
and how to utilize it. This project has purposes to conserve water and
reduce greenhouse gasses (bad air quality)
Job title : Project Manager

 Dates : 10/10/2015 to 10/10/2015

Title of the institution : Indonesian Girls Leading Our World (IGLOW) -  Indonesian Boys
Respecting Others (IBRO) by Peace Corps
Job title : Speaker on Session: Your Environment (talk about climate crisis, the
Greenhouse effect, and its solution. Discuss about some ways that
students be go green everyday)

 Dates : 01/10/2015 to 01/31/2015

Title of the institution : Let’s Cut Our Carbon (Seminar & Workshop about climate crisis & its
solution, green life style, and invite youths to take action, watching movie
about climate crisis and young contribution to its solution)
Job title : Project Manager

 Dates : 01/23/2015 to 01/25/2015

Title of the institution: Chemical Engineering Student Union - ITB
Job title : Homestay at Ciporeat Village, Bandung Regency, West Java. (staying on
ciporeat society, help them to do their jobs such as farm and livestock
cattle, installation biogas reactor and the reactor feeding with animal
waste from the livestock to produce biogas for their activities & home
based business, do workshop to ciporeat’s elementary school about how
to make ice cream from milk that produce from their livestock.

 Dates : 11/14/2014 to 11/16/2014

 Title of the institution : Youth for Climate Camp 2014 by National Council on Climate Change
Job title : Delegate of West Java Province

 Dates : 10/30/2014 to 10/31/2014

Title of the institution : International Seminar on Chemical Engineering 2014 - STKSR
Job title : Head of Logistic Divison

 Dates : 03/14/2014 to 03/16/2014

Title of the institution : ITB International Energy Conference 2014
Job title : Liaison Officer for International Delegates

M. Memberships in Associations, Clubs, etc., if not included in work

and volunteer experience:
Please include dates of internship or volunteer experience, title of the institution and job title. You
may enter more than one.

 Dates : 06/16/2015 to 07/30/2016

Association : Code for Bandung
Position : Research Team (2015 to 2016) & Staff on Logistic of Scrap-A-Thon (2015)

 Dates : 11/23/2014 to Present

Association : Youth for Climate Change Indonesia
Position : Coordinator of Regional I (Banten, Jabodetabek, West Java) (2015-2016)
Chairman of West Java Regional (2014-2015)
Member in Youth for Climate Change Pekanbaru (present)

 Dates : 11/16/2013 to 07/30/2016

Association : Chemical Engineering Students Union ITB
Position : Head of License Division of Indonesia Chemical Engineering Challenge (2016)
Staff on Sports & Community Division (2016-present)
Staff on Academic Division (2015-2016)
Staff on Conservator Division (2013-2015)

 Dates : 01/20/2013 to 07/30/2016

Association : Keluarga Paduan Angklung ITB
Position : Head of Sponsorship Division of Festival Paduan Angklung XIV (2014-2015)
Indonesia Delegate for Angklung Art Performing at Esplanade, Singapore (2014)
Staff on External Division (2013-2014)
Head of Event Divison of internal familiarity (2013)
N. Previous YSEALI Exchange or Workshop Experience:
 Dates : April 19th, 2016
Workshop : YSEALI Earth Day 2016 Sharing Session & Workshop – U.S. Embassy
Jakarta & American Corner ITB
Position : Participant

 Dates : September, 2015

Workshop : YSEALI Summatera Greeneration Summit 2015
Position : Participant

R. Personal Statement by Candidate

(No more than 250 words). Please discuss your background and interest in the program, what you
would hope to get out of it, and why you would be a good candidate for participation:

My interest in environmental begin with my experiences at my hometown, Jambi. This Jambi Province is
affected by haze every year. The students in Jambi province are forced to have stay away from schools
and colleges for 2-4 weeks due to this incident in every year. From those experienced, I swore to myself
that I have to do action for keeping my Indonesia from the vulnerability of environmental risk.

To realize my dream, I had done some activities with my communities focusing on environmental
conservation and utilize some waste to become things with added value, such as planting mangroves in
Pahawang Island, planting 210 seeds of bamboo & tree in Batu Lonceng village (this project aims for
reducing environmental crisis in Batu Lonceng which are water restriction and bad air quality),
distributing masks for the haze’s victims in Jambi, installing biogas reactor & cultivating “kascing” worm-
based fertilizer in Ciporeat village (biogas that produced by biogas reactor using as fuel for daily
activities and home businesses that created by housewife in village and kascing fertilizer that produced
by cultivation used as main fertilizer in their farming substituted the conventional fertilizer).

By join YSEALI Academic Fellowship program on Environmental issue, I believe I will improve my ability
and gain more knowledge in environmental issues. Moreover, by attending classes in the US university,
doing social-community development, interaction with ASEAN and US Youth, and others will develop my
skills to realize my dream to keep Indonesia and earth from environmental crisis.
S. Letter of Recommendation
At least one letter (maximum three letters) of recommendation from someone who knows you well
professionally (not from family or friend). Candidate who get invited to the interview process will
need to send us the original recommendation letter (scanned version of the letter that you put below.
Please provide it with the letter head).