DEPARTEMEN

PERENCANAAN WILAYAH DAN KOTA

MATAKULIAH KERJA PRAKTEK
Form SKP-03

No Letter : 03/08211640000063/KP/2019
Attachment : 1 (one) copied
Subject : Request for Guidance Assistance

To : SHIBAURA INSTITUTE OF TECHNOLOGY

With respect,
Following up on your letter No. REP2019062 On April 26, 2019 regarding the
permissibility of our students to carry out Lab Internship Program in your
Institution, we hereby delegate the coaching process while in your work
environment to you, in accordance with the applicable provisions of the project.
With this we also include 1 (one) administrative completeness file consisting of
a Internship Assessment Sheet (SKP-03.A), and Internship Activity Sheet (SKP-
03.B).
Besides giving guidance, we ask your willingness to give an assessment of the
performance of our students. Where, the assessment will be used as one of
the considerations in determining the final value of this course. In order to
maintain the confidentiality of the results of the assessment, we ask that you
send back the SKP-03.A form in a sealed envelope to us after the Job Training
period is complete.
Thus our letter of request, for your attention and cooperation, we would like
to thank you.

Surabaya, 8 June 2019

Internship Program Coordinator
Departemen of Urban & Regional Planning
ITS

Nursakti Adhi Pratomoatmojo, ST, M.Sc

NIP. 19841021 201504 1 002

Cc:
1. Chair of Departemen of Urban & Regional Planning
2. The student that concerned
 Form SKP-03.A
THE ASSESSMENT SHEET FOR INTERNSHIP
Name : Jihan Nabila Arifin
Student ID : 08211640000045
Supervisor : Prof. Shunji Suzuki
Name of Departement : SHIBAURA INSTITUTE OF TECHNOLOGY
Project / Reseach title : Omiya Streetscape Project

SCORE
PROPORTION SUM
NO Rated Aspect (S)
(P) (0-100)
(P X S)

1 Presence 10
2 Seriousness in carrying out Job Training 15
3 Discipline in completing work 10
4 Responsibility 15
5 Skills in Profession 20
6 Creativity / Innovation 15
7 Attitudes and Behaviors in Work 10
8 Ability to Cooperate in Teams 5
TOTAL 100

IN SUM (P X S)
FINAL SCORE = SUM OF = =
100
PROPORTION

Knowing,
Director / Head / Chairperson of the
Institution of SREP SIT
Japan, _______________
SREP Supervisor of Department of Urban
Design and Environment

Osamu Sugiyama
Prof. Shunji Suzuki
 DEPARTEMEN
PERENCANAAN WILAYAH DAN KOTA
MATAKULIAH KERJA PRAKTEK
Form SKP-03.B
LAB INTERNSHIP SCHEDULE PLAN
Name : Jihan Nabila Arifin
Student ID : 08211640000045
Supervisor : Prof. Shunji Suzuki
Name of Departement : SHIBAURA INSTITUTE OF TECHNOLOGY
Project / Reseach title : Omiya Streetscape Project

Supervisor
NO DATE NOTES AND COMMENTS
Signature
1. Orientation about the lab and the project
1 01/07/2019 2. Lab meeting
3. Discuss the internship study plan
1. Meeting with the UDCO (Urban Design Center
Omiya)
2 04/07/2019 2. Introduction about the streetscape project
3. Primary Survey in the field for the research
location in Omiya
1. Processing the data by analyze the photo
08/07/2019 –
3 taken in the research location using Adobe
16/07/2019
Illustrator and Hakariya
1. Discuss about the progress of photo analysis
4 22/07/2019 2. Seminar of Urban Design Talk ( @ Omiya
Ward Office)
1. Processing the data by analyze the photo
22/07/2019 –
5 taken in the research location Adobe
30/07/2019
Illustrator and Hakariya
1. Making the graph and the final result of the
photos analysis
2. Signage survey #1 : Observe the activity
6 30/08/2019 around the Map Sign
3. Meeting with UDCO the result of each photos
analysis

7 5/08/2019 1. Disscus about the revision thath UDCO gave

8 6/08/2019 1. Revision of the Photos Analysis
1. Signage survey #1 : Observe the activity
9 7/08/2019 around the Map Sign

7/08/2019 –
10 1. Creating powerpoint for final presentation
13/08/2019
1. Meeting with Professor about the progress
11 19/08/2019
final presentation and the assessment sheet
1. Final Presentation
12 23/08/2019 2. Farewell Party with the Professor and the
lab’s member
 DEPARTEMEN
PERENCANAAN WILAYAH DAN KOTA
MATAKULIAH KERJA PRAKTEK