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 : ..........................................................................................................................
..........................................................................................................................
..........................................................................................................................
..........................................................................................................................
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.

F01/PM-FK-AK-20

FK Unila Terakreditasi SNI ISO 9001-2015 PSPD FK Unila Terakreditasi A BAN-PT

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

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

F01/PM-FK-AK-20

FK Unila Terakreditasi SNI ISO 9001-2015 PSPD FK Unila Terakreditasi A BAN-PT