FORMAT PENGAJUAN USULAN JUDUL PROPOSAL / SKRIPSI

PRODI S1 PENDIDIKAN DOKTER

UNIVERSITAS NAHDLATUL ULAMA SURABAYA

Mahasiswa yang tersebut dibawah ini :

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

NIM : ..................................................................................................................
JudulSkripsi : ..................................................................................................................
..................................................................................................................

1. Pembimbing I : …………………………………………………………………………..
2. Pembimbing II : …………………………………………………………………………..
3. Pembimbing Statistik : …………………………………………………………………………..

Menyetujui :

Pembimbing I, Pembimbing II,

( ……………………….……… ) (………………………………. )

Pembimbing Statistik,

( ……………………….……… )
 FORMAT PERNYATAAN KESEDIAAN
MENJADI DOSEN PEMBIMBING TUGAS AKHIR
PRODI S1 PENDIDIKAN DOKTER
UNIVERSITAS NAHDLATUL ULAMA SURABAYA

Yang bertandatangan di bawah ini saya :

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

NPP :.............................................................................................
Gol / Pangkat / Ruang / Jabatan : ............................................................................................

Menyatakan dengan sebenar-benarnya bahwa saya BERSEDIA/ TIDAK BERSEDIA*

menjadi :

PEMBIMBING BERSEDIA TIDAK BERSEDIA*

DosenPembimbing I

DosenPembimbing II

Dosen Statistik

Tugas Akhir (skripsi) dari mahasiswa yang tersebut di bawah ini :

Nama Lengkap : .......................................................................................................
NIM : .......................................................................................................
Judul Proposal /Tugas Akhir
(skripsi ) : ....................................................................................................................................
....................................................................................................................................................
....................................................................................................................................................
................
Bila Tidak Bersedia, dengan alasan :
....................................................................................................................................................
....................................................................................................................................................

Demikian surat pernyataan ini saya buat dengan sebenar-benarnya untuk dipergunakan
sebagaimana mestinya.

Nama Dosen

.......................................................
NPP................................................
*) beritanda  didalam kotak dan coret yang tidak perlu
 FORMULIR PENDAFTARAN
UJIAN PROPOSAL/ SEMINAR HASIL/ SIDANG SKRIPSI
PRODI S1 PENDIDIKAN DOKTER
UNIVERSITAS NAHDLATUL ULAMA SURABAYA

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

NIM : ........................................................................................................
Judul Proposal Skripsi : ........................................................................................................
...........................................................................................................
...........................................................................................................
Dosen Pembimbing : 1)
...................................................................................................
2) ...................................................................................................
3) ...................................................................................................

Rencana Ujian

Hari : ......................................................................................................
.
Tanggal : .......................................................................................................
Waktu : .......................................................................................................
Ruang Ujian : .......................................................................................................

Surabaya,............................................
Mahasiswa,

..............................................................
.
 FORMULIR PENGAJUAN DOSEN PENGUJI
UJIAN PROPOSAL/ SEMINAR HASIL/ SIDANG SKRIPSI
PRODI S1 PENDIDIKAN DOKTER
UNIVERSITAS NAHDLATUL ULAMA SURABAYA

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

NIM : ........................................................................................................
Judul Proposal Skripsi : ........................................................................................................
...........................................................................................................
...........................................................................................................

Pelaksanaan Ujian

Hari : ......................................................................................................
.
Tanggal : .......................................................................................................
Waktu : .......................................................................................................
Ruang Ujian : .......................................................................................................
Dosen Pembimbing : 1)
...................................................................................................
2) ...................................................................................................
3) ...................................................................................................

*) Dosen Penguji :

Ketua Penguji : .........................................................................................................

Penguji I : .........................................................................................................
Penguji II : .........................................................................................................
Penguji III : .........................................................................................................

Surabaya,............................................
Ketua Program Studi

..............................................................
.
NPP.

Catatan:
*) Diisioleh Ketua Program Studi