2017-03-20 Formulir Permohonan Perpanjangan SK Dosen Pembimbing

UNIVERSITAS GADJAH MADA - FAKULTAS TEKNIK
UNIVERSITAS GADJAH MADA – FACULTY OF ENGINEERING
JURUSAN 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
PERPANJANGAN SURAT KEPUTUSAN (SK) DOSEN PEMBIMBING
(Application Form for Extension of Letter of Decree of Script /Thesis Advisor)
Berlaku maksimum 1 (satu) semester saja
Valid for maximum of 1 (one) semester

Nama Mahasiswa
(Name)

: ______________________________________________

NIM
(Student No.)

: ____________________________________

Angkatan
(Academic Year)

: ___________

Topik Penelitian
(Research Topic)

: ______________________________________________________________
______________________________________________________________
______________________________________________________________

Judul Sementara
(Tentative Title)

: ______________________________________________________________
______________________________________________________________
______________________________________________________________

______________________________________________________________

Pembimbing Utama
(Advisor)
Pembimbing Pendamping
(Co-Advisor)

: ____________________________________

Syarat-Syarat (Check-List)

: ____________________________________
:

1.
2.
3.

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

Draft yang sudah disetujui oleh pembimbing dan penguji ujian proposal
(Approved draft)
Fotokopi Surat Keputusan (SK) Dosen Pembimbing lama
(Copy of Previous Letter of Decree of Script/Thesis Advisor)

…..
…..
…..

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

(_______________ ___ )
Menyetujui,
(Approve)
Pengelola Program Studi
(Program Manager)

Pembimbing Utama
(Advisor)

(________________)

(_______________)