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