2017-04-06 Formulir 1 Yudisium Jurusan
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
Form 1
PERSETUJUAN YUDISIUM
(JUDICIUM APPROVAL)
Yang bertanda tangan di bawah ini adalah saya :
The undersigned below:
Nama
: …………………………………………………………………………...…………..
Name
NIM
: …………………………………………………………………………………….....
Student No.
Angkatan tahun
Academic Entry Year
Alamat
Address
Status kemahasiswaan
Student Status
Terdaftar pertama kali
: …………………………………………………………………………...…………..
: ……………………………………………………………………...………………..
……………………………………………………………………………………….
………………………………………………………………………………...……..
: Mahasiswa biasa/Tugas Belajar/Ikatan Dinas/………………………………………
Regular Student/Shcollarship Student/…………………...………………...………..
: ………………..……………………………………………………...………………
Date of First Registered
Judul Skripsi/Tesis
Title of Script/Thesis
Dengan Nilai
: ……………………………………………………………...…………..……………
……………………………………………………………………………………….
……………………………………………………………………………………….
: …………………………………………………..………………………...…………
Grade
Dosen Wali
: …………………………………………………..………………………...…………
Academic Advisor
Pembimbing Utama
: ….…………………………………………………………………......……………..
Script/Thesis Advisor
Pembimbing Pendamping I
: …………...….………………………………………...……………………………..
Script/Thesis Co-Advisor I
Pembimbing Pendamping II
: ..….………………………………………………………...………………….……..
Script/Thesis Co-Advisor II
Ujian pendadaran tanggal
: ………....………………………………………………...…………………………..
Date of Final Examination
Jumlah SKS
: …………………………………………………..………………………...…………
Number of Semester Credit Units
IP Kumulatif
: …………………………………………………..………………………...…………
Cummulative Grade-Point Average
Predikat
: …………………………………………………..………………………...…………
Predicate
Jumlah Mata Kuliah
: …………………………………………………..………………………...…………
Number of Course Subject
Sudah Diterima Kerja di
: …………………………………………………..………………………...…………
Employment Status
Menyatakan dengan sesungguhnya bahwa saya sudah memenuhi semua persyaratan akademik maupun administratif di Departemen
Teknik Geologi, Fakultas Teknik, Universitas Gadjah Mada.
Hereby state that I have fulfilled all the academic and administrative requirements in the Department of Geological Engineering, Faculty of Engineering, Gadjah Mada University .
Yogyakarta, ………………………
Ketua Departemen,
Head of Department
( ………………………………. )
( ………………………………. )
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
Form 1
PERSETUJUAN YUDISIUM
(JUDICIUM APPROVAL)
Yang bertanda tangan di bawah ini adalah saya :
The undersigned below:
Nama
: …………………………………………………………………………...…………..
Name
NIM
: …………………………………………………………………………………….....
Student No.
Angkatan tahun
Academic Entry Year
Alamat
Address
Status kemahasiswaan
Student Status
Terdaftar pertama kali
: …………………………………………………………………………...…………..
: ……………………………………………………………………...………………..
……………………………………………………………………………………….
………………………………………………………………………………...……..
: Mahasiswa biasa/Tugas Belajar/Ikatan Dinas/………………………………………
Regular Student/Shcollarship Student/…………………...………………...………..
: ………………..……………………………………………………...………………
Date of First Registered
Judul Skripsi/Tesis
Title of Script/Thesis
Dengan Nilai
: ……………………………………………………………...…………..……………
……………………………………………………………………………………….
……………………………………………………………………………………….
: …………………………………………………..………………………...…………
Grade
Dosen Wali
: …………………………………………………..………………………...…………
Academic Advisor
Pembimbing Utama
: ….…………………………………………………………………......……………..
Script/Thesis Advisor
Pembimbing Pendamping I
: …………...….………………………………………...……………………………..
Script/Thesis Co-Advisor I
Pembimbing Pendamping II
: ..….………………………………………………………...………………….……..
Script/Thesis Co-Advisor II
Ujian pendadaran tanggal
: ………....………………………………………………...…………………………..
Date of Final Examination
Jumlah SKS
: …………………………………………………..………………………...…………
Number of Semester Credit Units
IP Kumulatif
: …………………………………………………..………………………...…………
Cummulative Grade-Point Average
Predikat
: …………………………………………………..………………………...…………
Predicate
Jumlah Mata Kuliah
: …………………………………………………..………………………...…………
Number of Course Subject
Sudah Diterima Kerja di
: …………………………………………………..………………………...…………
Employment Status
Menyatakan dengan sesungguhnya bahwa saya sudah memenuhi semua persyaratan akademik maupun administratif di Departemen
Teknik Geologi, Fakultas Teknik, Universitas Gadjah Mada.
Hereby state that I have fulfilled all the academic and administrative requirements in the Department of Geological Engineering, Faculty of Engineering, Gadjah Mada University .
Yogyakarta, ………………………
Ketua Departemen,
Head of Department
( ………………………………. )
( ………………………………. )