20150105 Formulir Permohonan Dosen Pembimbing revised

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Universitas Gadjah Mada – Program Pascasarjana Fakultas Teknik

FORMULIR PERMOHONAN DOSEN PEMBIMBING (Advisor Proposal Form)

Nama Mahasiswa : ______________________________________________ (Name)

NIM : ____________________________________ (Student No.)

Angkatan : ___________ (Academic Year)

Topik Penelitian : ______________________________________________________________

(Research Topic) ______________________________________________________________ ______________________________________________________________

Judul Sementara : ______________________________________________________________

(Tentative Title) ______________________________________________________________ ______________________________________________________________

______________________________________________________________

Pembimbing Utama : ____________________________________ (Advisor)

Pembimbing Pendamping I : ____________________________________ (Co-Advisor I)

Pembimbing Pendamping II : ____________________________________ (Co-Advisor II)

Yogyakarta, _ _ _ _ _ _ _ __ _ _

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Pembimbing Utama Pembimbing Pendamping I Pembimbing Pendamping II

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Pengelola Program Studi S2 T. Geologi