FORMULIR PENGAJUAN CALON PENGUJI TUGAS AKHIR - Fakultas Kesehatan Masyarakat

FORMULIR PENGAJUAN CALON PENGUJI TUGAS AKHIR
Nama

: ………………………………………………………………………………………….

NIM

: ………………………………………………………………………………………….

Peminatan

: ………………………………………………………………………………………….

Judul penelitian

: ………………………………………………………………………………………….
………………………………………………………………………………………….
………………………………………………………………………………………….
………………………………………………………………………………………….

Dosen Pembimbing

: ………………………………………………………………………………………….

Usulan Penguji

:

1. ………………………………………………………………………………………………………………………
2. ………………………………………………………………………………………………………………………

Yogyakarta, …………………………………….
Dosen Pembimbing

Mahasiswa

(………………………………………………………………………….)
(……………………………………………………………………..)
NIY/NIP : ……………………………………………………….
NIM : ………………………………………………..

Syarat :
-

Sudah melaksanakan bimbingan tugas akhir minimal 3X
Fotokopi kartu bimbingan tugas akhir