Gadjah Mada University Faculty of Engineering

Graduate Program Departement of Geological Engineering

Form to Attend Qolokium Examination
Student Number : _________________________________________________________________
Name
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Date

Student Name Who Present Qolokium

Thesis Title

Moderator Signature

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Yogyakarta, _____________________
Head of Graduate Program
Geological Engineering

Dr. Agung Harijoko, ST., M.Eng.

Graduate Program Departement of Geological Engineering
Departement of Geological Engineering, Faculty of Engineering, Gadjah Mada University
Jl.Grafika No.2 Bulaksumur Yogyakarta 55281 Indonesia Phone/Fax +62 274 631181
Website: http://pasca.geologi.ugm.ac.id | E-mail: pasca_geologi@ugm.ac.id