FORMULIR PENDAFTARAN

PROGRAM MAGISTER MANAJEMEN AGRIBISNIS

Foto
4 cm x 6 cm

No. Tes : ..............................................

I. DATA PRIBADI
Nama Lengkap
(sesuai dengan ijazah S1)

: ........................................................................................................................................................

Gelar Kesarjanaan

: ........................................................................................................................................................

Tempat / Tanggal Lahir

: ........................................................................................................................................................

Agama

: ................................................................................................ Jenis Kelamin : ( L / P )

Status Perkawinan

Alamat Rumah/Korespondensi

: ........................................................................................................................................................

Menikah

Belum Menikah

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Telp. ( ..............) .................................................. HP ...............................................................
Email : ...................... ...................................................................................................................
Alamat Kantor

: .......................................................................................................................................................
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Telp. ( ..............) ................................................. HP ...............................................................
Email : .........................................................................................................................................

II. LATAR BELAKANG AKADEMIK

Nama Perguruan Tinggi (S1)

: ..................................................................................................................................................

Fakultas/Jurusan

: ....................................................................................... IPK : ...............................................

Pendidikan lain yang diperoleh

: ..................................................................................................................................................

Penghargaan Akademik

: ..................................................................................................................................................
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Kemampuan Bahasa Asing

Bahasa

Membaca*

Berbicara *

Menulis*

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* Diisi dengan pilihan: SB = Sangat Baik; B = Baik; C = Cukup; K = Kurang

Tes yang pernah diikuti

Jenis

Tanggal

Nilai

TOEFL

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GMAT

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TPA

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III. PENGALAMAN PEKERJAAN

(Ditulis secara kronologis, bila diperlukan dapat menggunakan lembar tersendiri)

Nama Instansi

Jabatan

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Lama Kerja
Dari tahun

Sampai dengan tahun

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IV. MOTIVASI DAN HARAPAN

1.

Motivasi Saudara mengikuti Program MMA-IPB

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2.

Karir apa yang akan Bapak/Ibu kembangkan setelah menyelesaikan Program MMA-IPB ?

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V. REFERENSI
Tuliskan nama atasan Bapak/Ibu (bagi yang telah bekerja) dan/atau dosen pembimbing Bapak/Ibu yang dapat
memberikan rekomendasi untuk mendukung pendaftaran Bapak/Ibu. Untuk rekomendasi hendaknya dipergunakan
formulir yang telah disediakan.
Pemberi rekomendasi
Status

: Atasan

Nama Lengkap

: ........................................................................................................................................................................

Pekerjaan

: ........................................................................................................................................................................

Alamat Kantor

: .......................................................................................................... Telp. : ( ............... )............................

Pemberi rekomendasi
Status

: Dosen Pembimbing

Nama Lengkap

: ........................................................................................................................................................................

Pekerjaan

: ........................................................................................................................................................................

Alamat Kantor

: .......................................................................................................... Telp. : ( ............... )............................

VI. PERNYATAAN PELAMAR

Dengan ini kami mendaftarkan diri pada :
PROGRAM MAGISTER MANAJEMEN AGRIBISNIS
PROGRAM PASCASARJANA MANAJEMEN DAN BISNIS - IPB
dan formulir ini telah kami isi dengan jujur, benar dan lengkap.
Nama

: .......................................................................................

Tanggal

: .......................................................................................

Tandatangan :

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RAHASIA

PROGRAM MAGISTER MANAJEMEN AGRIBISNIS

SURAT REKOMENDASI

(Diperlukan untuk pendaftaran ke Program Studi Magister Manajemen Agribisnis IPB)

Pemberi Rekomendasi
Nama

: ..................................................................................................................................

Jabatan/Pangkat : ..................................................................................................................................
Nama Institusi

: ..................................................................................................................................

Alamat Kantor

: ..................................................................................................................................
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Telp. (.............) ......................................................................................................

Calon Pendaftar
Nama

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1. Sudah berapa lama Bapak/Ibu mengenal calon peserta, dan dalam hubungan apa ?
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2. Apakah menurut Bapak/Ibu calon peserta mempunyai kemampuan untuk mengikuti dan menyelesaikan Program
Magister Manajemen Agribisnis IPB ?
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3. Menurut pandangan Bapak/Ibu, dalam hal-hal apa calon peserta dianggap menonjol ?
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4. Dalam hal-hal apa Bapak/Ibu menganggap calon peserta memiliki kelemahan ?
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5. Gunakan pilihan berikut ini untuk menilai calon peserta (beri tanda silang pada peringkat yang saudara pilih)

Baik
sekali

Baik

Rata-Rata

Kurang

Tidak
dapat
menilai

Kemampuan analitik

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Kemampuan konseptual

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Komunikasi lisan

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Komunikasi tertulis

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Inisiatif

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Kesungguhan

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Kemandirian

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Kemampuan mengatur penggunaan waktu

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Peluang berhasil dalam studi

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Berdasarkan informasi diatas, (No. 5) saya merekomendasikan / tidak merekomendasikan

*) Calon yang bersangkutan.

Keterangan
*) Coret yang tidak perlu.

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Pemberi Rekomendasi

(..................................................................)

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KELENGKAPAN PERSYARATAN
LAMARAN CALON PESERTA
1. Fotokopi ijazah dan transkrip nilai S1 dari berbagai disiplin ilmu yang telah dilegalisir oleh Perguruan
Tinggi asal, masing-masing satu lembar.
2. Mengisi formulir pendaftaran secara lengkap dengan menyertakan pasphoto berwarna 4 x 6 cm (2
lembar).
3. Surat rekomendasi dari atasan dan/atau dosen pembimbing S1.
4. Surat ijin / cuti belajar dari pimpinan instansi tempat calon peserta bekerja (bagi peserta kelas reguler yang
sedang bekerja).
5. Menyelesaikan biaya pendaftaran.
6. Mengikuti Tes Penerimaan (Tes Potensi Akademik, Tes Psikologi, dan Tes Bahasa Inggris yang meliputi
listening, vocabulary and reading ).
7. Mengikuti Tes Diagnostik dengan Materi: Pengantar Ekonomi, Pengantar Matematika dan Statistika,
Dasar-Dasar Akuntansi, dan Aplikasi Komputer (Tes Diagnostik dimaksudkan untuk menentukan mata
kuliah yang harus diikuti oleh calon peserta pada periode matrikulasi).

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