FM-BINUS-AA-FPU-754/R1

FORMULIR PERMOHONAN AKTIF KEMBALI

RE-ACTIVE APPLICATION FORM

Nama : Julian Marga Resta

Name
NIM : 2440125351
Student ID
Fakultas/ Sekolah : BINUS Malang
Faculty/ School
Program Studi : Sistem Informasi
Study Program
Program : Online Learning
Program
Jenjang Studi : S1
Education Level
Alamat : Jl. Raya Pare Wates
Address
Telepon  Rumah : (0354)395525
Phone Number Home
 Kantor : (0354)688307
Office
 HP : 085854453455
Mobile Phone
 E-mail : julian.resta@binus.ac.id

Alasan tidak aktif : Karena faktor Pekerjaan yang sangat padat dan jam istirahat yang kurang
The reason being inactive

:1 Tahun Akademik 2022 / 2023

Semester akan aktif kembali Academic Year
Period of re-active

Jakarta, 06 Oktober 2022

Hormat saya,
Sincerely Yours,

Julian Marga Resta

Mahasiswa
Student
 FM-BINUS-AA-FPU-754/R1

Diisi oleh Staf Layanan Mahasiswa

Filled by Student Services Staff

Aktif Terakhir Paraf Staf Layanan

Last Active
: ……………………………………………………..…… Signature by Student Service
Staff
Sisa Masa Studi : ……………………………………………………..……
Study Period Left
Batas Masa Studi : ……………………………………………………..……
Limit of Study Period
Jumlah Cuti : ……………………………………………………..……
Number of Official Leave
IPK Terakhir : ……………………………………………………..……
Last GPA
SKS Kumulatif : ……………………………………………………..……
Cumulative SCU
Status Peminjaman Buku Diperiksa oleh*
Book Lending Status
: ……………………………………………………..…… Checked by
Catatan : ……………………………………………………..……
Note

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Perjanjian: Ya/ Yes Tidak/ No

Agreement

Diisi oleh Staf Nilai

Filled by Grading Staff
KD MTK Nama Matakuliah Minimum Nilai UPM Nilai Paraf Staf Nilai
Course Code Course Name Grade Minimum Grade Signature by Grading Staff

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Diperiksa oleh*
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*Min. Binusian Grade 10 dari unit yg berwenang/ Min. Binusian Grade 10 from the authorized unit
 FM-BINUS-AA-FPU-754/R1

Rincian pembayaran diisi oleh Staf Administrasi Keuangan

Payment detail is filled by Financial Administration Staff
Jenis Rincian Biaya Cara Pembayaran Paraf
Item Cost Detail Payment Method Staf Admin Keuangan
Signature by Financial & Admin
Staff

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*Min. Binusian Grade 10 dari unit yg berwenang/ Min. Binusian Grade 10 from the authorized unit

Diisi oleh Staf Penjadwalan

Filled by Scheduling staff
Catatan: Paraf
Note Staf Penjadwalan
Signature by Scheduling Staff

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Diperiksa oleh*
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*Min. Binusian Grade 10 dari unit yg berwenang/ Min. Binusian Grade 10 from the authorized unit
 FM-BINUS-AA-FPU-753/R0
Diisi oleh Staf Layanan Mahasiswa
Filled by Student Service Staff
Catatan (Informasi ke Mahasiswa) (Telp/ e-mail)* Signature by Student Service
Note (Information to student) (Telp/ e-mail) Staff

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Mengetahui, Menyetujui/ Menolak,

Knowing Approve/ Reject

Manajer Operasional Dekan/ Kepala Sekolah ………………………….

Operational Manager Dean/ Head of School ……………………………
 FM-BINUS-AA-FPU-753/R0

Formulir Penambahan Mata Kuliah

Additional Subject Form
Semester: Ganjil dan Genap (*) Tahun Akademik/ Academic Year: 2022/2023 Periode: 1 dan 2 (*)

Admit Term:….Masa Studi: 4 tahun Aktif Terakhir: 2019 SKS:….. IPK:….

NIM/ Student ID : 2440125351

Tanggal/ Date : 06/10/2022
Program Studi/ Study Program : Sistem Informasi
Nama/ Name : Julian Marga Resta

PENTING!!!
 Formulir ini hanya berlaku untuk matakuliah yang dibuka pada periode tersebut.
 Matakuliah yang diulang adalah grade D/E dan matakuliah MPM (Matakuliah Pengawasan Mutu).
 Jumlah matakuliah yang Anda tambah tidak boleh melebihi maksimal matakuliah yang diikuti per periode (3
matakuliah).
 Pengisian yang tidak lengkap/ tidak jelas tidak akan diproses !!!
Diisi oleh mahasiswa
Detail is filled by Student
KD MTK Nama Mata Kuliah Nilai Minimum Nilai SKS
UPM
Course Code Course Name Minimum Grade Grade Credit
COMP6598 Introduction to Programming D No E 4
ISYS6299 Information Systems Concept D No E 4
ACCT6174 Introduction to Financial Accounting D No E 4
ISYS6300 Business Process Fundamental D No E 4
ISYS6597 Introduction to Database Systems D No E 4
CHAR6019 Character Building: Pancasila B Yes E 2
LANG6031 Indonesian D No E 2
ISYS6611 Information Systems Analysis and Design C Yes E 6
ISYS6507035 Testing and System Implementation D No E 4
ISYS6601035 User Experience Research and Design D No E 6
Total 40

Diisi oleh Staf Nilai

Detail is filled by Grading Staff
KD MTK Nama Mata Kuliah Nilai Minimum Nilai SKS
UPM
Course Code Course Name Minimum Grade Grade Credit

Total
(*) Coret yang tidak perlu

Signature by:

Student Student Service Staff Grading Staff Checked by

FM-BINUS-AA-FPU-753/R0
 FM-BINUS-AA-FPU-753/R0

Rincian pembayaran diisi oleh Staf Administrasi Keuangan

Payment detail is filled by Financial Administration Staff
Jenis Rincian Biaya Cara Pembayaran Paraf
Item Cost Breakdown Payment Method Staf Administrasi
Keuangan
Signature by Finance Adm.Staff

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Diperiksa oleh*
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*Min. Binusian Grade 10 dari unit yg berwenang/ Min. Binusian Grade 10 from the authorized unit

Diisi oleh Staf Penjadwalan

Filled by Scheduling staff
Catatan: Paraf
Note Staf Penjadwalan
Signature by Scheduling Staff

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Diperiksa oleh*
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*Min. Binusian Grade 10 dari unit yg berwenang/ Min. Binusian Grade 10 from the authorized unit

Diisi oleh Staf Layanan Mahasiswa

Filled by Student Service Staff
Catatan (Informasi ke Mahasiswa) (Telp/ e-mail)* Signature by Student Service
Note (Information to student) (Telp/ e-mail) Staff

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