KEMENTERIAN RISET, TEKNOLOGI DAN PENDIDIKAN TINGGI

UNIVERSITAS LAMPUNG
FAKULTAS KEDOKTERAN
Jalan Prof. Dr. Soemantri Brojonegoro No. 1 Telp/Fax (0721) 7691197 Bandar Lampung 35145
Laman : http://www.fk.unila.ac.id Email: dekanfkunila@yahoo.com

FORMULIR PENGAJUAN
USUL JUDUL DAN PEMBIMBING SKRIPSI

NAMA MAHASISWA : ........................................................................................................................

NPM : ........................................................................................................................
SEMESTER : ........................................................................................................................
USUL JUDUL SKRIPSI* :
1. JUDUL : ........................................................................................................................
........................................................................................................................
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........................................................................................................................
CABANG ILMU : ........................................................................................................................
PEMBIMBING I : ........................................................................................................................
PEMBIMBING II : ........................................................................................................................
PEMBAHAS : ........................................................................................................................

2. JUDUL : ........................................................................................................................
........................................................................................................................
........................................................................................................................
........................................................................................................................
CABANG ILMU : ........................................................................................................................
PEMBIMBING I : ........................................................................................................................
PEMBIMBING II : ........................................................................................................................
PEMBAHAS : ........................................................................................................................

3. JUDUL : ........................................................................................................................
........................................................................................................................
........................................................................................................................
........................................................................................................................
CABANG ILMU : ........................................................................................................................
PEMBIMBING I : ........................................................................................................................
PEMBIMBING II : ........................................................................................................................
PEMBAHAS : ........................................................................................................................

Bandar Lampung, ………………………….......…

Tim Skripsi,

……………………………….......………
NIP.

* Jumlah minimal pengajuan usul judul skripsi adalah 2 (dua) judul

F01/PM-FK-AK-20