(Updated on 23 June 2014)

1st SEAMEO Youth Leadership Forum

Application Form
Note: Please ensure that you have read the SELECTION CRITERIA before filling out
this form.
Please fill out in BLOCK LETTERS. You may fill out the form electronically or manually.
(1) Last name: WIBAWA
(2) First name(s): I GUSTI AGUNG ADITYA SURYA
(3) Date of birth (dd/mm/yyyy): 20/01/1993

(4) Sex: MALE

(5) Nationality: INDONESIA

(6) Name of school: DIPONEGORO UNIVERSITY
(7) Address of school: PROF. SUDHARTO TEMBALANG, SEMARANG, CENTRAL
JAVA - INDONESIA
(8) University course: GEOLOGICAL ENGINEERING
(9) Currently enrolled in an undergraduate program?
Yes (answer questions 10 and 11)
No (answer question 12)
(10) Year level: 3

(11) Expected graduation date: APRIL 2015

(12) Date of graduation:

If currently employed answer questions 13 to 16.
(13) Job position:

(14) Date of employment:

(15) Job responsibilities:

(16) Name and address of office:
(17) If you have other previous professional experiences, please describe them briefly below:
INTERNSHIP IN CHEVRON PASIFIC INDONESIA
INTERNSHIP IN Central Cipta Murdaya with project case Business Plan and Flagship Store
Design for Juwara Brand

(18) Leadership experience (use a separate page if necessary)

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(Updated on 23 June 2014)

Name of organization(s)
a. SOCIETY OF INDONESIA
PETROLEUM ENGINEER

Post(s) held

Period of service

PRESIDENT

2014 - 2015

INSTITUTION
MANAGER

2013 - 2014

DEPARTMENT
HEAD OF
EXTERNAL
RELATION

2013 - 2014

DIVISION HEAD OF
ART

2013 - 2014

STAFF PROJECT
QUALITY
CONTROL FOR
GLOBAL
COMMUNITY
DEVELOPMENT
PROGRAM

2012

Accomplishments:
b. AIESEC LOCAL COMMITTEE
DIPONEGORO UNIVERSITY
Accomplishments:
c. SOCIETY OF INDONESIA
PETROLEUM ENGINEER

Accomplishments:
d. COLLAGE STUDENT EXECUTIVE
BOARD ENGINEERING FACULTY,
DIPONEGORO UNIVERSITY
Accomplishments:
e. AIESEC LOCAL COMMITTEE
DIPONEGORO UNIVERSITY

Accomplishments:
(19) Interests: MUSIC, ENERGY DEVELOPMENT, PROJECT MANAGEMENT,
CHILDREN EDUCATION, COMMUNICATION
(20) Special skills:
I have several special talents and skills that I feel very represent myself. Which are :
The first one is music especially in singing. I start my journey to learn and also hone my skill
from I still in elementary school until now. I join several competitions and also become
representative of Indonesia in some of national and international event. Oneof memorable
moment that I can got from this talent that God give to me is when Igot thechance become
oneof therepresentatives ofIndonesiato joined inanextraordinaryconcert, which is aseries
ofASEANsubmit, which was held inBalion December2011. I
reallycantbelieveit,whenmynamewas called to gotoYogyakartatoconducttrainingfor
twoweeks beforethe concertwas held. In there,Ijoinedwitharound 60talented young
musiciansfromIndonesia, Russiaandtheothercountries which are ASEANs members.A series

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of concertsentitledASEAN -RussiaSymphony Orchestra took inthreedifferent placesonBali.
And atthiseventis my second timesangin front ofMr.SusiloBambangYudhoyono,whois
thePresidentof Indonesiaafter I became representative from Central Java sang in Gita Bahana
Nusantara that was national event in Istana Merdeka.And that occasion is also my first time
to sang in front of Mr. Obama that was representative from US and the ministers and officials
from ASEAN member countries.
The second one are in leadership, public speaking,and also project managementskill.I got that
several skills from experiances that I got when I involve in several organization and event
from I still in Junior High School until now. That improve mypersonal a lot and make me
more confident on public activityeither in individual and also in team. Because that skill I
already got some achievement from some institution and companyin national and
international level. Like, I elected being TOP 60 in Young Leaders for Indonesia wave 6East
Asia Regionlevelin 2014 (a program targeted at high performing third and final year students
with execellent academic and leadership credentials that held by McKinsey & Company),
beside that I also become 2nd winner of The Most Oustanding Student program in my
universityon 2014, and recepient of leadershipdevelopment program and scholarship from
PT. Astra International, Tbk from 2012 until now, in this program I also got chance for being
chairman in national social project thats called Leader Activation and director of logistic in
national professional project thats called Career Fast 2014with Astra Honda Motor.
The thirdone in energy development and also geological site.This skill I got from my collage
that I still learn until now. Majoring in geological engineering make me now several things
about energyfrom the way how to got that energy resources, how to do mapping for know the
potensial resources from one place, know about how to do exploration and exploitation
activity for that, and also until the way how to utilize that energy resources. From that skill I
can got several ocassion for represent my major, university and my country. That are like I
can be one of Indonesian representative in International Student Energy Summit that was
held in Trondheim, Norway on June 2013. I can went to Calgary, Canada on October 2013
being representative from Student Energy Association in World Petroleum Council Youth
Forum that discuss many kind of issues and things that connected with renewable energy and
energy policy.On January2014, I also can join in PELTAC event inJohor Bahru, Malaysia
that organized by Universiti Teknologi Malaysia. Because that ability and several ocassion
that I already joining in my past, now Ican stand as president in Society of Indonesia
Petroleum Engineer Student Chapter Diponegoro University in term 2014 2015 and one of
trainee in PT. Chevron Pasific Indonesia with concentration topic in Qualitative Analysis :
Identification of Lithology Type, Fluid, Facies, and Depositional Environment BaseOn Data
of Gamma Ray, Resistivity, Density and Neutron Log from Agung Well at PT. Chevron
Pasific Indonesia
(21) Languages spoken: INDONESIAN (NATIVE), ENGLISH (EXCELLENT), BALINESE
(NATIVE), MALAY (SPEAK ONLY), JAPAN (BASIC)

(22) Answer all the questions below in essay form. All essays should be in one MS Word
document and with your name on the first page. Word count for each question should be
about 250 words.
a. What is your envisioned career path?
b. How will you benefit from the 1st SEAMEO Leadership Forum? What do you
think are the actions or activities you could implement based on what you will
learn from the Forum?

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c. Why should you be chosen to participate in the Forum?
Checklist of Required Documents:
1. Filled out application form
2. Essays
3. Letter of recommendation
4. Transcript of records or copy of grades
5. Curriculum vitae (optional)
Note: You may scan all the required documents and email or post them to us.
Submission (DEADLINE: 08 August 2014)
1. Email to: girard@seameo-spafa.org or spafa@seameo-spafa.org
2. Or post it to (subject: SEAMEO Youth Leadership Forum):
SEAMEO SPAFA
81/1 Si Ayutthaya Road, Thewet, Dusit
Bangkok, 10300, Thailand
For inquiries, contact: Tel: +662-2804022 up to 9; Fax: +662-2804030

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