20150105 Formulir Permohonan Dosen Pembimbing revised

Universitas Gadjah Mada – Program Pascasarjana Fakultas Teknik
Program Studi S2 Teknik Geologi
FORMULIR PERMOHONAN DOSEN PEMBIMBING
(Advisor Proposal Form)
Nama Mahasiswa
(Name)

: ______________________________________________

NIM
(Student No.)

: ____________________________________

Angkatan
(Academic Year)

: ___________

Topik Penelitian
(Research Topic)

: ______________________________________________________________
______________________________________________________________
______________________________________________________________

Judul Sementara
(Tentative Title)

: ______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________

Pembimbing Utama
: ____________________________________
(Advisor)
Pembimbing Pendamping I : ____________________________________
(Co-Advisor I)
Pembimbing Pendamping II : ____________________________________
(Co-Advisor II)

Yogyakarta, _ _ _ _ _ _ _ __ _ _

(_______________ ___ )
Menyetujui
Pembimbing Utama
Pendamping II

(________________)

Pembimbing Pendamping I

(________________)

Menyetujui
Pengelola Program Studi S2 T. Geologi

(________________)

Pembimbing

(_______________)