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FORMULIR PERMOHONAN PENCARIAN DATA

GUNA KEPERLUAN TUGAS AKHIR

Nama : ………………………………………………………………………….
NIM : …………………………………………………...
Semester : ……………………
Program Studi : Pendidikan Dokter / PSIK / PSIG / PSPDG/ Kebidanan / Farmasi
Tujuan (Penelitian) : Studi Pendahuluan / Uji Validitas / Pengambilan Data (Penelitian)
Judul Penelitian :
…………………………………………………………………………………………………………….
…………………………………………………………………………………………………………….
…………………………………………………………………………………………………………….
…………………………………………………………………………………………………………….
Pembimbing :
1. ………………………………………………………………………..
2. ………………………………………………………………………..
Tujuan (Tempat) :
1. ……………………………………………………………………………………………………..
2. ……………………………………………………………………………………………………..
3. ……………………………………………………………………………………………………..
4. ……………………………………………………………………………………………………..
5. ……………………………………………………………………………………………………..

Mengetahui,
Ketua TIM TA FKUB, Mahasiswa,

.............................................. ……………………………………………………..
NIP. NIM.

FORMULIR PERMOHONAN PENCARIAN DATA


GUNA KEPERLUAN TUGAS AKHIR

Nama : …………………………………………………………………………….
NIM : …………………………………………………...
Semester : ……………………
Program Studi : Pendidikan Dokter / PSIK / PSIG / PSPDG / Kebidanan / Farmasi
Tujuan (Penelitian) : Studi Pendahuluan / Uji Validitas / Pengambilan Data (Penelitian)
Judul Penelitian :
…………………………………………………………………………………………………………….
…………………………………………………………………………………………………………….
…………………………………………………………………………………………………………….
…………………………………………………………………………………………………………….
Pembimbing :
1. ………………………………………………………………………..
2. ………………………………………………………………………..
Tujuan (Tempat) :
1. ……………………………………………………………………………………………………..
2. ……………………………………………………………………………………………………..
3. ……………………………………………………………………………………………………..
4. ……………………………………………………………………………………………………..
5. ……………………………………………………………………………………………………..

Mengetahui,
Ketua TIM TA FKUB, Mahasiswa,

.......................................... ……………………………………………………..
NIP. NIM.

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