FORMULIR C

REKOMENDASI UNTUK CALON PESERTA

PROGRAM MAGISTER TEKNOLOGI INFORMASI
INSTITUT SAINS DAN TEKNOLOGI TERPADU SURABAYA (ISTTS)

1. Nama Calon : ............................................................................................................................

2. Telah berapa lama Saudara mengenal calon dan dalam hubungan apa ?...........................................

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3. Menurut Saudara, apa yang merupakan unsur-unsur kemampuan / kekuatan utama calon ?

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4. Menurut Saudara, apakah yang merupakan kelemahan / kekurangan utama calon ?

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5. Menurut Saudara, hingga seberapa jauh calon telah memikirkan / mempersiapkan diri untuk

mengikuti program

Magister ? .............................................................................................................................................

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6. Bagaimanakah Saudara menilai calon : (Beri tanda  pada kotak yang tersedia)
 Sangat Baik Baik Kurang
Uraian Baik Rata-rata
Sekali Sekali Baik
a. Kemampuan Intelektual
b. Ketekunan Belajar / Bekerja
c. Kemampuan Mengatur
Penggunaan Waktu
d. Kemampuan Bahasa Inggris
atau Bahasa Asing Lainnya
(Sebutkan)
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Pemberi Rekomendasi :

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

Jabatan : ...............................................................................................................................

Instansi : ...............................................................................................................................

Alamat : ...............................................................................................................................

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Telepon / HP / CDMA : ...............................................................................................................................

Tanggal : ...............................................................................................................................

Pemberi Rekomendasi

( )
Nama Terang & Stempel

Perhatian :
- Calon peserta dapat memperbanyak / fotocopy sesuai kebutuhan
- Surat rekomendasi dapat dimasukkan dalam amplop tertutup