FAKULTAS TEKNIK UNIVERSITAS GADJAH MADA

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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: [email protected]

FORMULIR PERMOHONAN UJIAN PROPOSAL SKRIPSI DAN TESIS (Script And Thesis Proposal Examination Form)

Nama Mahasiswa : _______________________________________________________

(Name)

NIM : _______________________________________________________

(Academic No.)

Angkatan : _______________________________________________________

(Academic Year)

No. Telepon : _______________________________________________________

Phone Number

Email : _______________________________________________________

Email

Judul : _______________________________________________________

(Title) _______________________________________________________

_______________________________________________________

Dosen Pembimbing Utama : _______________________________________________________

(Advisor)

Dosen Pembimbing Pendamping : _______________________________________________________

(Co-Advisor)

Dosen Wali : _______________________________________________________

Academic Advisor

Syarat-Syarat (Check-List)

: 1. Draft yang sudah disetujui oleh pembimbing (Approved draft)

…..

2. Salinan Kartu Hasil Studi (Copy of Progress Report)

…..

3. Salinan Kartu Mahasiswa yang masih berlaku (Copy of a valid student card)

…..

4. Salinan Kartu Rencana Studi (Copy of Course Selection Form)

…..

5. Salinan Formulir Kesediaan Dosen Pembimbing (Copy of Advisor Proposal Form)

…..

6. Khusus untuk tesis, salinan hasil tes AcEPT/TOEFL dan PAPs/TPA

(Only for thesis, Copy of TOEFL-Like and TPA result)

…..

Mengetahui Yogyakarta, ………..

Acknowledged Mahasiswa,

Pengelola Student

Academic Affair/Program Manager

( ………) ( ………)

NIP. NIM.