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FORMULIR PERMOHONAN PENCARIAN DATA

GUNA KEPERLUAN TUGAS AKHIR

Nama : ………………………………………………………………………….
NIM : …………………………………………………...
Semester : ……………………
Program Studi : Ilmu Keperawatan
Tujuan (Penelitian) : Studi Pendahuluan / Uji Validitas / Pengambilan Data (Penelitian)
Judul Penelitian :
…………………………………………………………………………………………………………….
…………………………………………………………………………………………………………….
…………………………………………………………………………………………………………….
…………………………………………………………………………………………………………….
Pembimbing :
1. ………………………………………………………………………..
2. ………………………………………………………………………..
Tujuan (Tempat) :
1. ……………………………………………………………………………………………………..
2. ……………………………………………………………………………………………………..
3. ……………………………………………………………………………………………………..
4. ……………………………………………………………………………………………………..
5. ……………………………………………………………………………………………………..

Mengetahui,
Koordinator TA, Mahasiswa,

Ns. Niko Dima K, S.Kep, M.Kep, Sp.Kep.Kom NIM.


NIK. 2013018712202001

FORMULIR PERMOHONAN PENCARIAN DATA


GUNA KEPERLUAN TUGAS AKHIR

Nama : …………………………………………………………………………….
NIM : …………………………………………………...
Semester : ……………………
Program Studi : Ilmu Keperawatan
Tujuan (Penelitian) : Studi Pendahuluan / Uji Validitas / Pengambilan Data (Penelitian)
Judul Penelitian :
…………………………………………………………………………………………………………….
…………………………………………………………………………………………………………….
…………………………………………………………………………………………………………….
…………………………………………………………………………………………………………….
Pembimbing :
1. ………………………………………………………………………..
2. ………………………………………………………………………..
Tujuan (Tempat) :
1. ……………………………………………………………………………………………………..
2. ……………………………………………………………………………………………………..
3. ……………………………………………………………………………………………………..
4. ……………………………………………………………………………………………………..
5. ……………………………………………………………………………………………………..

Mengetahui,
Koordinator TA, Mahasiswa,

Ns. Niko Dima K, S.Kep, M.Kep, Sp.Kep.Kom NIM.


NIK. 2013018712202001

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