KEMENTERIAN RISET, TEKNOLOGI, DAN PENDIDIKAN TINGGI

UNIVERSITAS JENDERAL SOEDIRMAN

FAKULTAS PERTANIAN
Jl. dr. Soeparno Telp. (0281) 638791 Purwokerto 53123

SYARAT PENDADARAN

Nama Mahasiswa :...................................................................................................

NIM :...................................................................................................
Jurusan :...................................................................................................
Program Studi :...................................................................................................

No Syarat - syarat Keterangan

1 Foto Copy Kartu Studi Mahasiswa (KSM)
2 Surat Keterangan Selesai Praktek Penelitian
3 Tanda Terima Skripsi dari Perpustakaan Unsoed dan Fakultas
4 Tanda Terima Skripsi dari Pembimbing I dan Pembimbing II
5 Surat Keterangan Bebas Laboratorium
6 Biodata Alumni ( rangkap 3 )
7 Formulir Pendaftaran / Persyaratan Ujian Akhir Tingkat Sarjana ( Rangkap 3 )
8 Menyerahkan Skripsi dan CD Skripsi
9 Foto Copy Transkrip Sebanyak 8 Lembar
10 Foto Ukuran 3 x 4 ( 2 lbr ) Hitam Putih, dan Ukuran Kartu Pos 1 Lembar (bebas )
11 Ringkasan dan Summary Masing-masing Sebanyak 8 Lembar
12 Usulan Penelitian dan PKL ( Tanda Terima dari Masing-masing Program Studi )
13 Foto Copy Toefl

Purwokerto,................................20....
Subag Akademik dan Kemahasiswaan.

.........................................................
NIP.
Catatan : Stopmap Sesuai Program Studi/ Jurusan
Agroteknologi : Warna Hijau
Tek. Pert. : Warna Biru
Sosek : Warna Merah

SURAT KETERANGAN
SELESAI PRAKTEK PENELITIAN

Yang bertanda tangan di bawah ini menerangkan bahwa :

Nama : ....................................................................................................................
NIM : ....................................................................................................................
Program Studi : ....................................................................................................................
Jurusan : ....................................................................................................................

Telah selesai melaksanakan Praktek Penelitian dengan judul :

......................................................................................................................................................................

.....................................................................................................................................................................

.....................................................................................................................................................................

.....................................................................................................................................................................

......................................................................................................................................................................

Mulai Tanggal : .................................................................................

Sampai Dengan : .................................................................................
Di : .................................................................................
Kecamatan : .................................................................................
Kabupaten : .................................................................................

Demikian untuk diketahui dan digunakan seperlunya.

Diketahui :

Pembimbing I Pembimbing II

............................................................... ...............................................................
NIP....................................................... NIP.......................................................

TANDA TERIMA SKRIPSI

Yang Bertanda Tangan Dibawah Ini :

Nama :................................................................

NIM :................................................................

Telah Menyerahkan Skripsi Kepada Pembimbing I Dengan Judul :

...................................................................................................................................

...................................................................................................................................

...................................................................................................................................

...................................................................................................................................

Demikian untuk dapat digunakan sebagai persyaratan pendaftaran pendadaran

Purwokerto, .................................20...
Yang menerima, Yang menyerahkan
Pembimbing II

NIP NIM

TANDA TERIMA SKRIPSI

Yang Bertanda Tangan Dibawah Ini :

Nama :................................................................

NIM :................................................................

Telah Menyerahkan Skripsi Kepada Pembimbing II Dengan Judul :

...................................................................................................................................

...................................................................................................................................

...................................................................................................................................

...................................................................................................................................

Demikian untuk dapat digunakan sebagai persyaratan pendaftaran pendadaran

Purwokerto, .................................20...
Yang menerima, Yang menyerahkan
Pembimbing II

NIP NIM

FORMULIR PERSYARATAN UJIAN AKHIR TINGKAT SARJANA

FAKULTAS PERTANIAN

1. Nama Lengkap : ...........................................................................................

2. Nomor Induk Mahasiswa : ...........................................................................................
 3. Program Studi : ...........................................................................................
4. Tempat Tgl. Lahir : ...........................................................................................
5. Masuk Fak. Pertanian : ...........................................................................................
6. Alamat Kost : ...........................................................................................
7. Alamat Rumah : ...........................................................................................
8. Sripsi : ...........................................................................................
Mulai Tanggal/Bulan : ...........................................................................................
Selesai s/d Ujian Skripsi : ...........................................................................................
Judul : ...........................................................................................
...........................................................................................
Dosen Pembimbing I : ...........................................................................................
Dosen Pembimbing II : ...........................................................................................
9. Praktik Kerja Lapang : ...........................................................................................
Mulai Tgl / Bulan : ...........................................................................................
Selesai Ujian Tgl : ...........................................................................................
Judul : ...........................................................................................
...........................................................................................
Dosen Pembimbing : ...........................................................................................
10. Kuliah Kera Nyata : ...........................................................................................
Mulai Tanggal : ...........................................................................................
Selesai tanggal : ...........................................................................................
Nilai : ...........................................................................................
11. Lokasi Kuliah Kerja Nyata : ...........................................................................................
Desa : ...........................................................................................
Kecamatan : ...........................................................................................
Kabupaten : ...........................................................................................
12 . Dosen Pemb. Lapangan : ...........................................................................................
Kuliah Kerja Nyata : ...........................................................................................
13. IPK Sebelum Ujian Akhir : ...........................................................................................

Mengingat pentingnya data-data tersebut di atas sebagai bahan untuk pembuatan ijazah, maka
telah saya isi dengan sebenarnya. Apabila dikemudian hari ternyata palsu saya bersedian
menerima resikonya.

Purwokerto, ............................20......
Yang Membuat

............................................................
NIM
KEMENTERIAN RISET, TEKNOLOGI, DAN PENDIDIKAN TINGGI
UNIVERSITAS JENDERAL SOEDIRMAN
FAKULTAS PERTANIAN
Jl. dr. Soeparno Telp. (0281) 638791 Purwokerto 53123
Perihal : Surat keterangan bebas pinjaman laboratorium
Fakultas Pertanian Unsoed

Yth. Sub. Bagian Akademik dan Kemahasiswaan

Fakultas Pertanian Unsoed
Purwokerto

Yang bertanda tangan dibawah ini menerangkan bahwa :

Nama : ...................................................................................................
NIM : ...................................................................................................
Jurusan : ...................................................................................................
Program Studi : ...................................................................................................
Tingakat : ...................................................................................................

Telah menyelesaikan tugasnya, baik praktek laboratorium, lapangan dan sudah tidak lagi
mempunyai tenggungan / pinjaman alat-alat laboratorium Fakultas Pertanian Unsoed.
Kemudian harap menjadi maklum dan digunakan seperlunya.

1. Kepala Lab. Tanah/Sumberdaya Lahan 2. Kepala Lab. Perlindungan Tanaman

................................................................................... ............................................................................
3. Kepala Lab. Agronomi dan Hortikultura 4. Kepala Lab. Pemuliaan Tanaman dan
Bioteknologi

.......................................................................... .......................................................................
5. Kepala Lab. Perenc. Dan Pengembangan 6. Kepala Lab. Manajemen Agribisnis
Sumberdaya

Alpha Nadeira Mandamdari, S.P., M.P. Ratna Satriani, S.P., M.Sc.

7. Kepala Lab. Teknologi Pengolahan 8. Kepala Lab. Manajemen Agroindustri

................................................................................... .............................................................................
9. Kepala Lab. Pangan dan Gizi 10. Kepala Lab. Mekanisasi Pertanian

................................................................................. .............................................................................
11. Kepala Lab. Komputer 12.

.................................................................................

KEMENTERIAN RISET, TEKNOLOGI, DAN PENDIDIKAN TINGGI

UNIVERSITAS JENDERAL SOEDIRMAN
FAKULTAS PERTANIAN
Jl. dr. Soeparno Telp. (0281) 638791 Purwokerto 53123
Perihal : Surat keterangan bebas pinjaman laboratorium
Fakultas Pertanian Unsoed

Yth. Sub. Bagian Akademik dan Kemahasiswaan

Fakultas Pertanian Unsoed
Purwokerto

Yang bertanda tangan dibawah ini menerangkan bahwa :

Nama : ...................................................................................................
NIM : ...................................................................................................
Jurusan : ...................................................................................................
Program Studi : ...................................................................................................
Tingakat : ...................................................................................................

Telah menyelesaikan tugasnya, baik praktek laboratorium, lapangan dan sudah tidak lagi
mempunyai tenggungan / pinjaman alat-alat laboratorium Fakultas Pertanian Unsoed.
Kemudian harap menjadi maklum dan digunakan seperlunya.

1. Kepala Lab. Teknik Pengelolaan dan 2. Kepala Lab. Alat dan Mesin Pertanian
Pengendalian Bio Lingkungan

Dr. Asna Mustofa, S.TP., M.P. Ir. Masrukhi, MP.

NIP. 19690803 200312 1 001 NIP. 19610201 198803 1 002
3. Kepala Lab. Teknik Pengolahan Pangan 4. Kepala Lab. Teknik Sistem Termal dan
dan Hasil Pertanian Energi Terbarukan

Ir. Agus Margiwiyatno, M.S., Ph.D Dr. Ir. Wiludjeng Trisasiwi, M.P
NIP. 19620222 198702 1 001 NIP. 19630808 198803 2 001
5. Kepala Lab. Sistem Informasi dan
Manajemen Industri Pertanian

Ir. Sidharta Sahirman, M.S., MSIE., Ph.D

NIP. 19540919 198702 1 001

KEMENTERIAN RISET, TEKNOLOGI, DAN PENDIDIKAN TINGGI

UNIVERSITAS JENDERAL SOEDIRMAN
FAKULTAS PERTANIAN
Jl. dr. Soeparno Telp. (0281) 638791 Purwokerto 53123

ISIAN BIODATA ALUMNI

Nama : ...........................................................................................
NIM : ...........................................................................................
Jenis Kelamin : ...........................................................................................
Tempat Lahir : ...........................................................................................
Tanggal Lahir : ...........................................................................................
Tanggal Lulus : ...........................................................................................
IPK : ...........................................................................................
Predikat : ...........................................................................................
Agama : ...........................................................................................
Alamat Rumah : ...........................................................................................
...........................................................................................
...........................................................................................
HP : ...........................................................................................
Tahun Masuk : ...........................................................................................
Fakultas : ............................................................................................
Jurusan : ............................................................................................
Prog. Studi : ............................................................................................
Lama Studi : ............................................................................................
Asal SLTA : ............................................................................................
Tgl Lulus SLTA : ............................................................................................
Nama Orang Tua : ............................................................................................
Pekerjaan Orang Tua : ...........................................................................................
Alamat Orang Tua : ...........................................................................................
...........................................................................................
...........................................................................................
...........................................................................................
Judul Laporan : ...........................................................................................
...........................................................................................
...........................................................................................
...........................................................................................
Pembimbing Utama : ...........................................................................................

Yang Membuat

.......................................

TANDA TERIMA USULAN PENELITIAN DAN PKL

1. Telah terima usulan penelitian dengan judul :

..........................................................................................................................................................
..........................................................................................................................................................
..........................................................................................................................................................
..........................................................................................................................................................
 2. Laporan Praktik Kerja Lapangan dengan Judul :
..........................................................................................................................................................
..........................................................................................................................................................
..........................................................................................................................................................
..........................................................................................................................................................

Dengan demikian dapat digunakan sebagai persyaratan Untuk Pendadaran)

Purwokerto,
Yang menerima Yang Menyerahkan
Ketua Program Studi

............................................................................... ...............................................................................
NIP.

KEMENTERIAN RISET, TEKNOLOGI, DAN PENDIDIKAN TINGGI

UNIVERSITAS JENDERAL SOEDIRMAN
FAKULTAS PERTANIAN
Jl. dr. Soeparno Telp. (0281) 638791 Purwokerto 53123

SYARAT YUDISIUM
NAMA : ...................................................................................................................

NIM : ...................................................................................................................

PRODI / JURUSAN : ...................................................................................................................

NO. URUT : ...................................................................................................................

No. Pesyaratan Checklist

1 Foto Copy Kwitansi SPP / UKT
2 Transkrip 15 lembar
3 Surat keterangan unggah artikel ilmiah
4 Surat Keterangan Bebas Perpustakaan Unsoed dan Fakultas

Purwokerto,..............................................20........
Petugas Pendaftaran

............................................................
NIP.