Formulir Permohonan Ujian S 3 final

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UNIVERSITAS GADJAH MADA - FAKULTAS TEKNIK

UNIVERSITAS GADJAH MADA – FACULTY OF ENGINEERING

DEPARTEMEN TEKNIK GEOLOGI

DEPARTMENT OF GEOLOGICAL ENGINEERING

Jl.Grafika No.2 Kampus UGM, Yogyakarta 55281 Indonesia Telp. (0274) 513668 Fax (0274) 546039 Website: http://geologi.ugm.ac.id | E-mail: jtg.ft@ugm.ac.id

FORMULIR PERMOHONAN SEMINAR/KOLOKIUM/UJIAN

(

Seminar/Colloquium/Examination Proposal Form

)

Nama Mahasiswa : ___________________________________________________________

(Name)

NIM : ___________________________________________________________

(Academic No.)

Angkatan : ___________________________________________________________

(Academic Year)

No. Telepon : ___________________________________________________________

Phone Number

Email : ___________________________________________________________

Email

Judul : ___________________________________________________________

(Title) ___________________________________________________________

___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________

Dosen Pembimbing Utama : ___________________________________________________________

(Promoter)

Jenis Permohonan (Proposal Type) :

Ujian proposal (proposal exam)1 _{Seminar I}2 _{Seminar II}3

Kelayakan disertasi (review of disertation) 4 _{Kelayakan/Ujian Tertutup}_{(final exam)} 5 _{Ujian Terbuka}_{(Open exam)} 6

Persyaratan (Requirements) :

1. Aktif di semester berjalan (Active) 1,2,3,4,5,6  2. Sertifikat TOEFL dan TPA (Copy of TOEFL/TPA certificate) 1  3. Salinan kartu hasil studi (Copy of progress report) 1  4. Salinan log book/kartu konsultasi (Copy of log book) 1,2,3,4,5  5. Publikasi, terlampir (Publication, attached) 3,4,5,6

a. Prosiding seminar nasional (national conference proceedings) 

b. Prosiding seminar internasional (international conference proceedings) 

c. Jurnal nasional terakreditasi (national acreditated journal) 

d. Jurnal internasional (international journal) 

e. Jurnal internasional terindeks (indexed international journal) 

6. Draf yang sudah disetujui oleh pembimbing (Approved draft) 1,2,3,4,5,6 

Mengetahui Yogyakarta, ………..

Acknowledged Mahasiswa,

Pengelola Student

Academic Affair/Program Manager

( ………) ( ………)

NIP. NIM.