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PT: <Universitas/Institut/PT Seni/Sekolah Tinggi/Akademi/Politeknik>1

Kelompok: <I/II/III>2

Tema: Tema A, Tema B, Tema C, Tema D3

Jenis Proposal: Proposal Awal, Proposal Lengkap4

PROPOSALPROGRAM HIBAH KOMPETISI

BERBASIS INSTITUSIProses Seleksi Tahun 2010

(Nama Perguruan Tinggi)

Direktorat Jenderal Pendidikan TinggiDepartemen Pendidikan Nasional

2010

1 Pilih yang sesuai dengan pengelompokan institusi.2 Pilih yang sesuai dengan tiered scheme.3 Berilah tanda untuk tema-tema yang diajukan dalam proposal (boleh lebih dari satu).4 Berilah tanda untuk jenis proposal yang sesuai.

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b)PHK-I Proses Seleksi 2010 <Nama PT> Proposal Awal

Lembar Identifikasi

1. Nama Perguruan Tinggi : ____________________________________

2. Penanggung Jawab : ____________________________________

3. Ketua PelaksanaN a m a : ____________________________________Alamat : ____________________________________Telepon Kantor : ____________________________________Telepon Cellular : ____________________________________Fax : ____________________________________e-mail : ____________________________________

4. Tema yang dipilih : Tema A, Tema B, Tema C Tema D

5. 1. Kelompok : <I/II/III>

<Tempat, tanggal…………..>

Penanggung Jawab,< pemimpin perguruan tinggi >

(____________________________________)

Ringkasan Eksekutif halaman ii

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Data Akreditasi Prodi

Nama Perguruan Tinggi : ___________________________________________

Jumlah Seluruh Prodi : ___________________________________________

Jumlah Prodi Terakreditasi A : ?? program (??%)

Daftar Program Studi beserta AkreditasinyaData selengkapnya akreditasi ?? Prodi di <Nama Universitas> disajikan pada Lampiran A (lihat halaman 2)

Ringkasan Eksekutif halaman iii

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Daftar Isi

Lembar Identifikasi.......................................................................................................................ii

Data Akreditasi Prodi..................................................................................................................iii

Daftar Isi........................................................................................................................................iv

Daftar Tabel..................................................................................................................................vi

Daftar Gambar..............................................................................................................................vi

Daftar Lampiran...........................................................................................................................vi

Daftar Tabel Evaluasi Diri...........................................................................................................vi

Daftar Singkatan..........................................................................................................................vii

Ringkasan Eksekutif..................................................................................................................viii

Bab I. Ringkasan Renstra Pengembangan <Nama PT>....................................................I-1I.A Visi <Nama PT>.....................................................................................................I-1I.B Misi <Nama PT>.....................................................................................................I-1I.C Tujuan.....................................................................................................................I-1I.D Sasaran....................................................................................................................I-1I.E Capaian <Nama PT> sampai Tahun 2009..............................................................I-1I.F Pola pikir PHK-I <Nama PT> untuk mendukung tujuan institusi..........................I-1

Bab II. Laporan Evaluasi Diri <Nama PT>........................................................................II-1II.A Analisis Lingkungan Eksternal..............................................................................II-1

II.A.1 Daya Saing Daerah dan Nasional............................................................II-1II.A.1.1 Peluang....................................................................................II-1II.A.1.2 Tantangan................................................................................II-1

II.A.2 Mutu, Relevansi dan Akses.....................................................................II-1II.A.2.1 Peluang....................................................................................II-1II.A.2.2 Tantangan................................................................................II-1

II.A.3 Daya Saing Global...................................................................................II-1II.A.3.1 Peluang....................................................................................II-1II.A.3.2 Tantangan................................................................................II-1

II.B Evaluasi Berbagai Hibah di <Nama PT>..............................................................II-1II.B.1 <Nama PHK 1>.......................................................................................II-1II.B.2 <Nama PHK 2>.......................................................................................II-1II.B.3 <Nama PHK dst>....................................................................................II-1

II.C Evaluasi sistem tatakelola dan organisasi perguruan tinggi..................................II-1II.D Evaluasi kinerja dan manajemen program akademik............................................II-1

II.D.1 <Sub-bab 1>............................................................................................II-1II.D.2 <Sub-bab 2>............................................................................................II-1II.D.3 <Sub-bab dst>..........................................................................................II-1

II.E Evaluasi ketersediaan dan manajemen sumberdaya..............................................II-1II.E.1 Fasilitas fisik............................................................................................II-1II.E.2 Sumberdaya manusia...............................................................................II-2

II.E.2.1 Staf akademik..........................................................................II-2II.E.2.2 Staf non-akademik..................................................................II-2II.E.2.3 Mahasiswa...............................................................................II-2

Ringkasan Eksekutif halaman iv

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II.E.2.3.1 Penerimaan Mahasiswa..........................................II-2II.E.2.3.2 Profil Rasio Kompetisi Mahasiswa Masuk

<Nama PT>............................................................II-2II.E.2.4 Profil Mahasiswa....................................................................II-2

II.E.3 Sumber dana............................................................................................II-2II.F Evaluasi sistem penjaminan mutu di tingkat institusi...........................................II-2

II.F.1 <Sub-bab 1>............................................................................................II-2II.F.2 <Sub-bab 2>............................................................................................II-2II.F.3 <Sub-bab dst>..........................................................................................II-2

II.G Ringkasan hasil analisis evaluasi diri....................................................................II-2II.G.1 <Sub-bab 1>............................................................................................II-2II.G.2 <Sub-bab 2>............................................................................................II-2II.G.3 <Sub-bab dst>..........................................................................................II-2

II.H Ringkasan strategi/solusi alternatif........................................................................II-2II.H.1 <Sub-bab 1>............................................................................................II-2II.H.2 <Sub-bab 2>............................................................................................II-2II.H.3 <Sub-bab dst>..........................................................................................II-2

II.I Nilai baseline indikator kinerja.............................................................................II-2II.I.1 <Sub-bab 1>............................................................................................II-2II.I.2 <Sub-bab 2>............................................................................................II-2II.I.3 <Sub-bab dst>..........................................................................................II-3

Bab III. Rancangan Global Program Pengembangan.......................................................III-1III.A Penetapan Tema...................................................................................................III-1III.B Program Pengembangan.......................................................................................III-1

III.B.1 Tema C...................................................................................................III-1III.B.1.1 Latar Belakang.......................................................................III-1III.B.1.2 Tujuan dan Program..............................................................III-1

III.B.2 Tema B...................................................................................................III-1III.B.2.1 Latar Belakang.......................................................................III-1III.B.2.2 Tujuan dan Program..............................................................III-1III.B.2.3 Rancangan Program...............................................................III-1

III.B.3 Tema D...................................................................................................III-1III.B.3.1 Latar Belakang.......................................................................III-1III.B.3.2 Tujuan dan Program..............................................................III-1III.B.3.3 Rancangan Program...............................................................III-1

Ringkasan Eksekutif halaman v

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Daftar Tabel

Gambar I-1. Gambar apa saja yang penting..................................................................................I-1

Daftar Gambar

Tabel II-1. Tabel apa saja yang penting......................................................................................II-3

Daftar Lampiran

Lampiran A. Data Akreditasi Prodi S1 di <Nama PT>..................................................................IILampiran B. Kronologi Penyusunan Proposal Awal.....................................................................IIILampiran C. Evaluasi Diri <Nama PT>........................................................................................IVLampiran D. SK Tim Persiapan PHK-I 2010..............................................................................VIILampiran E. SK Tim Penyusun Proposal PHK-I 2010..............................................................VIIILampiran F. Renstra <Nama PT> 2008-2012...............................................................................IXLampiran G. Dokumentasi..............................................................................................................X

Daftar Tabel Evaluasi Diri

Tabel ED 1. Rekap Penerimaan Dana Hibah 3 Tahun Terakhir (2007-2009)..............................IVTabel ED 2. Luas Bangunan dalam m2 (2009)..............................................................................IVTabel ED 3. Jumlah Dosen Tetap Berdasarkan Jabatan Akademik/Fungsional (2005-2009)......IVTabel ED 4. Jumlah Dosen Tetap Berdasarkan Kualifikasi Akademik dan Jenis Kelamin (2009).......................................................................................................................................................IVTabel ED 5. Jumlah Dosen Tetap Berdasarkan Kualifikasi Akademik (2006-2009)...................IVTabel ED 6. Jumlah Tenaga Non-Dosen Berdasarkan (2009)......................................................IVTabel ED 7. Jumlah Tenaga Non-Dosen Berdasarkan Kualifikasi Akdemik (2006-2009)............VTabel ED 8. Jumlah Tenaga Non-Dosen Berdasarkan Golongan (2009).......................................VTabel ED 9. Jumlah Program Studi di <Nama PT> (2006–2009)..................................................VTabel ED 10. Selektivitas Mahasiswa Baru <Nama PT> (2006-2009)..........................................VTabel ED 11. Jumlah Mahasiswa Berdasarkan Asal Daerah..........................................................VTabel ED 12. Sumber Dana (2007-2009).......................................................................................VTabel ED 13. Sumber Dana Beasiswa di <Nama PT> (2009)......................................................VI

Ringkasan Eksekutif halaman vi

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Daftar Singkatan

Ringkasan Eksekutif halaman vii

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Ringkasan Eksekutif

Ringkasan Eksekutif halaman viii

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Bab I. Ringkasan Renstra Pengembangan <Nama PT>

I.A Visi <Nama PT>

I.B Misi <Nama PT>

I.C Tujuan

I.D Sasaran

I.E Capaian <Nama PT> sampai Tahun 2009

I.F Pola pikir PHK-I <Nama PT> untuk mendukung tujuan institusi

Gambar I-1. Gambar apa saja yang penting

Laporan Evaluasi Diri <Nama PT> halaman 1

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Bab II. Laporan Evaluasi Diri <Nama PT>

II.A Analisis Lingkungan EksternalII.A.1 Daya Saing Daerah dan Nasional

II.A.1.1 Peluang

II.A.1.2 Tantangan

II.A.2 Mutu, Relevansi dan Akses

II.A.2.1 Peluang

II.A.2.2 Tantangan

II.A.3 Daya Saing Global

II.A.3.1 Peluang

II.A.3.2 Tantangan

II.B Evaluasi Berbagai Hibah di <Nama PT>

II.B.1 <Nama PHK 1>

II.B.2 <Nama PHK 2>

II.B.3 <Nama PHK dst>

II.C Evaluasi sistem tatakelola dan organisasi perguruan tinggi

II.D Evaluasi kinerja dan manajemen program akademikII.D.1 <Sub-bab 1>

II.D.2 <Sub-bab 2>

II.D.3 <Sub-bab dst>

II.E Evaluasi ketersediaan dan manajemen sumberdayaII.E.1 Fasilitas fisik


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II.E.2 Sumberdaya manusiaII.E.2.1 Staf akademik

II.E.2.2 Staf non-akademik

II.E.2.3 Mahasiswa

II.E.2.3.1 Penerimaan Mahasiswa

II.E.2.3.2 Profil Rasio Kompetisi Mahasiswa Masuk <Nama PT>

II.E.2.4 Profil Mahasiswa

II.E.3 Sumber dana

II.F Evaluasi sistem penjaminan mutu di tingkat institusi.

II.F.1 <Sub-bab 1>

II.F.2 <Sub-bab 2>

II.F.3 <Sub-bab dst>

II.G Ringkasan hasil analisis evaluasi diriII.G.1 <Sub-bab 1>

II.G.2 <Sub-bab 2>

II.G.3 <Sub-bab dst>

II.H Ringkasan strategi/solusi alternatifII.H.1 <Sub-bab 1>

II.H.2 <Sub-bab 2>

II.H.3 <Sub-bab dst>

II.I Nilai baseline indikator kinerjaII.I.1 <Sub-bab 1>

II.I.2 <Sub-bab 2>

Evaluasi sistem penjaminan mutu di tingkat institusi. halaman 2

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II.I.3 <Sub-bab dst>

Tabel II-1. Tabel apa saja yang penting

Evaluasi sistem penjaminan mutu di tingkat institusi. halaman 3

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Bab III. Rancangan Global Program Pengembangan

III.A Penetapan Tema

III.B Program Pengembangan

III.B.1 Tema C

III.B.1.1 Latar Belakang

III.B.1.2 Tujuan dan Program

III.B.2 Tema B



III.B.2.3 Rancangan Program

III.B.3 Tema D



III.B.3.3 Rancangan Program


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LAMPIRAN

Lampiran halaman I

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Lampiran A. Data Akreditasi Prodi S1 di <Nama PT>

Lampiran A. Data Akreditasi Prodi S1 di <Nama PT> halaman II

PHK-I Proses Seleksi 2010 <Nama PT> Proposal Awal

Lampiran B. Kronologi Penyusunan Proposal Awal

Lampiran B. Kronologi Penyusunan Proposal Awal halaman III

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Lampiran C. Evaluasi Diri <Nama PT>

Tabel ED 1. Rekap Penerimaan Dana Hibah 3 Tahun Terakhir (2007-2009)No. Hibah Jurusan/Fakultas Thn Jumlah Dana

Tabel ED 2. Luas Bangunan dalam m2 (2009)Type of Room Total Classrooms Laboratories Supporting

facilitiesOffices & Other

facilities

Tabel ED 3. Jumlah Dosen Tetap Berdasarkan Jabatan Akademik/Fungsional (2005-2009)

No Jabatan Akademik Tahun2005 2006 2007 2008 2009

Tabel ED 4. Jumlah Dosen Tetap Berdasarkan Kualifikasi Akademik dan Jenis Kelamin (2009)

No Ijazah L PJumla

h %

Tabel ED 5. Jumlah Dosen Tetap Berdasarkan Kualifikasi Akademik (2006-2009)

No Tahun Kualifikasi Akdemik JumlahS1 Profesi S2 S3

Lampiran G. Dokumentasi halaman IV

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No Tahun Kualifikasi Akdemik JumlahS1 Profesi S2 S3

Tabel ED 6. Jumlah Tenaga Non-Dosen Berdasarkan (2009)Usia 18 - 25 26 - 35 36 - 45 46 - 56 57 - 60 >= 61

Jumlah%

Tabel ED 7. Jumlah Tenaga Non-Dosen Berdasarkan Kualifikasi Akdemik (2006-2009)

No Year

Kualifikasi Akdemik JumlahSD SLT

PSLT

ASMK

Diploma S1 Profes

i S2 S3

1234

Tabel ED 8. Jumlah Tenaga Non-Dosen Berdasarkan Golongan (2009)Level I II III IV Total

Number %

Tabel ED 9. Jumlah Program Studi di <Nama PT> (2006–2009)Tahun 2006 2007 2008 2009Level

D3S1S2S3

ProfessionSpecialist

Total

Tabel ED 10. Selektivitas Mahasiswa Baru <Nama PT> (2006-2009)

Jalur Masuk

2006 2007 2008 2009

Peminat Diterima Selektivitas Peminat Diterima Selekti

vitas Peminat Diterima Selektivitas Peminat Diterima Selekti

vitas

Total

Tabel ED 11. Jumlah Mahasiswa Berdasarkan Asal Daerah

Asal Tahun2005 2006 2007 2008 2009

JawaLuar JawaLuar Negeri

Lampiran G. Dokumentasi halaman V

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Tabel ED 12. Sumber Dana (2007-2009)No Jenis Dana 2007 2008 20091 Dana Pemerintah2 Dana Masyarakat

3 Dana Hasil Usaha dan Tabungan

4 Dana Luar Negeri5 Dana Lain

Tabel ED 13. Sumber Dana Beasiswa di <Nama PT> (2009)No Sumber Dana 2009123

Lampiran G. Dokumentasi halaman VI

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Lampiran D. SK Tim Persiapan PHK-I 2010

Lampiran G. Dokumentasi halaman VII

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Lampiran E. SK Tim Penyusun Proposal PHK-I 2010

Lampiran G. Dokumentasi halaman VIII

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Lampiran F. Renstra <Nama PT> 2008-2012

Renstra <Nama PT> 2008-2012 disajikan pada kantong di sampul belakang proposal.

Lampiran G. Dokumentasi halaman IX

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Lampiran G. Dokumentasi

Lampiran G. Dokumentasi halaman X

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