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 CALON DOSEN PEMBIMBING SRIPSI/TESIS (Supervisors Candidate Proposal Form)
Nama Mahasiswa : ______________________________________________
(Name)
NIM : ____________________________________
(Student No.)
Angkatan : ___________
(Academic Year)
Topik Usulan Penelitian : ______________________________________________________________
(Proposed Research Topic) ______________________________________________________________
______________________________________________________________
Usulan Judul Sementara : ______________________________________________________________
(Proposed Tentative Title) ______________________________________________________________
______________________________________________________________
______________________________________________________________
Calon Pembimbing Utama : ____________________________________
(Supervisor Candidate)
Calon Pembimbing Pendamping : ____________________________________
(Co-Supervisor Candidate)
Yogyakarta, _ _ _ _ _ _ _ __ _ _
( _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ )
Menyetujui (Approve)
Menyetujui Calon Pembimbing Utama Calon Pembimbing Pendamping
(Approve) (Supervisor Candidate) (Co-Supervisor Candidate)
Pengelola Program Studi (Program Manager)
( _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ) ( _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ) ( _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ )
