Universitas Gadjah Mada Program Pascasarjana

Program Studi Teknik Geologi

FORMULIR PERMOHONAN PELAKSANAAN UJIAN TUGAS AKHIR
(Thesis Final Examination Proposal Form)
Nama Mahasiswa
(Name)

: ______________________________________________

NIM
(Academic No.)

: ____________________________________

Angkatan
(Academic Year)

: ___________

Judul
(Title)

: ______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________

Dosen Pembimbing Utama

:
______________________________________________________________
(Main Advisor)
Dosen Pembimbing Pendamping : ___________________________________________________________
(Co-Advisor)
Syarat-Syarat
.....
(Check-List)

: 1. Draft yang sudah disetujui oleh pembimbing

(Approved draft)
2. Salinan Bukti pembayaran semester terakhir

.....
(Copy of Last semester tuition fee payment slip)
3. Salinan Kartu Rencana Studi
(Copy of Course Selection Form)
4. Salinan Kartu Hasil Studi

.....

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(Copy of Study Progress Report)
5. Salinan Log Book
.....
(Copy of log book)
6. Salinan Hasil AcEPT/TOEFL dan PAPs/TPA
(Copy of AcEPT/TOEFL and PAPs/TPA results)
7. Salinan Berita Acara Seminar Qolokium
.....
(Copy of Qolokium Minute of Meeting)

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

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