CBDE team Application
Formulir Pendaftaran Research Interest Group CBDE (Consumer Behavior and Digital Ethics)

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Apakah Anda sudah menjadi member RIG lain? *
Jika Anda menjawab Sudah, RIG apakah?
Full Name (without title) *
Title/Gelar (depan dan belakang) *
Gender *
Position
Employee ID
NIDN (Nomor Induk Dosen Nasional) *
Place of birth *
Date of birth *
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Email *
Handphone/WhatsApp *
Office address *
Office phone no. *
Graduates produced (S1 ... students, S2  ... students , S3  ... students  ) 
Course/field of study where the member is a lecturer *
Education Profile
S1 (Sarjana)
University *
Field of Study *
Year of Enrollment – Graduation (eg. 1995-2000) *
Title of Thesis
Supervisor
S2 (Master)
University
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Field of Study
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Year of Enrollment – Graduation (eg. 1995-2000)
 *
Title of Thesis
 *
Supervisor
 *
S3 (Doctor)
University *
Field of Study *
Year of Enrollment – Graduation (eg. 1995-2000) *
Title of Thesis
SINTA Profile of Research Experience (e.g. https://sinta.kemdikbud.go.id/authors/profile/26295/?view=researches ) *
Google Scholar Profile of Scientific Publication (e.g. https://scholar.google.com/citations?user=QHRk4KYAAAAJ&hl=en ) *
Three Best Science Conference’s public speaker in the last 5 years
  Conference name  (1)
Scientific Article Title (1)
Place (1)
Date (1)
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  Conference name  (2)
Scientific Article Title (2)
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Place (2)
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Date (2)
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Conference name (3)
Scientific Article Title (3)
Place (3)
Date (3)
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SINTA Profile of Intellectual Property Right/HAKI  (e.g. https://sinta.kemdikbud.go.id/authors/profile/26295/?view=iprs )
Experience In Formulating a social engineering/public policy in the last 10 years
The type and the title of Social Engineering/Public policy that has been formulated (1)  
Year (1)
Implemented Place (1)
Community Response (1)
The type and the title of Social Engineering/Public policy that has been formulated (2)  
Year (2)
Implemented Place (2)
Community Response (2)
The type and the title of Social Engineering/Public policy that has been formulated (3)  
Year (3)
Implemented Place (3)
Community Response (3)
Saya berkomitmen untuk mempublikasi minimal 1 (satu) paper terindeks Scopus per tahun dalam RIG CBDE *
Statement
The data filled in this profile are true and accountable to law. 

I am willing to face the consequences if any of the data are proven wrong in the future. 

This biodata is made to fulfill one of the requirements in submitting application to be member of CBDE BINUS Research Interest group.   
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