BUKTI LEMBAR OBSERVASI

Yang bertanda tangan di bawah ini :

Nama Lengkap : .............................................................................................................
Jabatan : .............................................................................................................
Nama Lembaga/Instansi : ..............................................................................................................
Alamat Instansi : ..............................................................................................................

Membenarkan bahwa mahasiswa di bawah ini :

Nama : .............................................................................................................
NIN : ..............................................................................................................
Prodi : ..............................................................................................................
Telah melakukan observasi (pengamatan) awal dalam rangka perencanaan penelitian / pentusunan
skripsi / Tugas Akhir yang dilakukan pada :
Hari, tanggal : ................................................................................................................
Pihak yang ditemui : ................................................................................................................
Dengan hasil sebagai berikut :
a. Masalah yang ditemui
1. ........................................................................................................................................
2. ........................................................................................................................................
3. ........................................................................................................................................
b. Bukti adanya masalah (lengkap dengn data, foto, catatan kejadian, kutipan berita di media massa
atau lainya)
1. .........................................................................................................................................
2. .........................................................................................................................................
3. ..........................................................................................................................................
4. ..........................................................................................................................................
5. ..........................................................................................................................................
c. Penyebab adanya masalah tersebut
1. ...........................................................................................................................................
2. ...........................................................................................................................................
3. ...........................................................................................................................................
4. ...........................................................................................................................................
5. ...........................................................................................................................................
d. Dampat masalah tersebut
1. ...........................................................................................................................................
2. ...........................................................................................................................................
3. ...........................................................................................................................................
4. ............................................................................................................................................
5. ............................................................................................................................................

Jayapura,

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Kepala, Dosen Pembimbing Akademik

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