FAKULTAS PERTANIAN-PETERNAKAN

PROGRAM STUDI TEKNOLOGI PANGAN

teknologi-pangan@umm.ac.id
DAFTAR PERIKSA KELENGKAPAN ADMINISTRASI UJIAN SKRIPSI
PROGRAM STUDI TEKNOLOGI PANGAN (TP)

NAMA : .................................................................................

NIM : .................................................................................

NO.TELP : .................................................................................

PEMBIMBING : 1. ............................................................................

2. .............................................................................

1. FC Ijazah SMU/MA/STM/Sederajat (2 kali)

2. Foto ijazah berwarna 3 x 4 , 6 lembar ditempel, 2 lembar masukkan plastik
kecil klip.
3. Foto ijazah berwarna 4 x 6 , 2 lembar
4. FC Sertifikat KKN DPPM (2 kali)
5. Tanda terima soft copy foto dari BAA
6. FC Sertifikat dan Transkrip Bahasa Inggris (ESP)
7. Kuitansi Pembayaran : (2 kali)
a. Pendaftaran Ujian Skripsi
b. Herregristasi dan SPP terakhir
8. Transkrip sementara dibubuhi tanda tangan Dosen Wali / Ketua Jurusan
9. Form ujian skripsi dari TU Fakultas
a. Biodata Mahasiswa (untuk penulisan ijazah & panduan wisuda)
b. Persetujuan Dosen Pembimbing
10. Kartu daftar hadir seminar pkl & proposal skripsi
11. Kartu bimbingan skripsi/tugas akhir
12. Berita Acara Seminar Proposal Skripsi
13. Bukti Print Validasi SKPI dari Fakultas
14. SK Pembimbing Skripsi
15. Foto Copy KTP
Malang, .............................. 20........

(.......................................................)
 FAKULTAS PERTANIAN-PETERNAKAN
PROGRAM STUDI TEKNOLOGI PANGAN
teknologi-pangan@umm.ac.id

BIODATA MAHASISWA
(untuk penulisan ijazah)

Nama (Sesuai Ijazah SLTA) : ............................................................................................................

Tempat / tgl. Lahir : ............................................................................................................
No. Induk Mahasiswa : ............................................................................................................
Jurusan : T P (TEKNOLOGI PANGAN)
Jenis Kelamin : ............................................................................................................
Alamat di Malang : ............................................................................................................
No. Telp. dan HP : ............................................................................................................
E-mail : ............................................................................................................
Alamat Asal : ............................................................................................................
LengkapNo. Telp. : ............................................................................................................
Judul Skripsi : ............................................................................................................
............................................................................................................
............................................................................................................
Judul skripsi bahasa Inggris : ..............................................................................................................
.................................................................................................................
.................................................................................................................
Total SKS dan IPK : ............................................................................................................
Nama Orang Tua
Ayah : ............................................................................................................
Nama Ibu : ............................................................................................................
Alamat Orang Tua + No.Telp :
Pekerjaan Orang Tua
Ayah : ............................................................................................................
Ibu : ............................................................................................................

Foto Warna Foto Warna

Foto 4 x 6 Foto 4 x 6 Foto Warna Foto Warna
Foto 3 x 4 Foto 3 x 4

Malang,......................20..
Mhs. yang bersangkutan,

...............................
 FAKULTAS PERTANIAN-PETERNAKAN
PROGRAM STUDI TEKNOLOGI PANGAN
teknologi-pangan@umm.ac.id

BIODATA MAHASISWA
(untuk buku panduan wisuda & transkrip)
Nama (Sesuai Ijazah SLTA) : ............................................................................................................
Tempat / tgl. Lahir : ............................................................................................................
No. Induk Mahasiswa : ............................................................................................................
Jurusan : T P (TEKNOLOGI PANGAN)
Jenis Kelamin : ............................................................................................................
Alamat di Malang : ............................................................................................................
No. Telp. dan HP : ............................................................................................................
E-mail : ............................................................................................................
Alamat Asal : ............................................................................................................
LengkapNo. Telp. : ............................................................................................................
Judul Skripsi : ............................................................................................................
............................................................................................................
............................................................................................................
Judul Skripsi Bahasa Inggris :

Total SKS dan IPK : ............................................................................................................

Nama Orang Tua
Ayah : ............................................................................................................
Nama Ibu : ............................................................................................................
Alamat Orang Tua + No.Telp : ............................................................................................................
Pekerjaan Orang Tua
Ayah : ............................................................................................................
Ibu : ............................................................................................................
Foto ijazah berwarna : 4 x 6 sebanyak 2 lembar beserta
Foto ijazah berwarna : 3 x 4 sebanyak 8 lembar

Foto warna 3 x 4 Foto warna 3 x 4 Foto warna 3 x 4 Foto warna 3 x 4

Malang,......................20..
Mhs. yang bersangkutan,

.........................................
 FAKULTAS PERTANIAN-PETERNAKAN
PROGRAM STUDI TEKNOLOGI PANGAN
teknologi-pangan@umm.ac.id

LEMBAR PERSETUJUAN UJIAN SKRIPSI

Nama :

Tempat / tgl. Lahir :

NIM :

Jurusan : T P (TEKNOLOGI PANGAN)

JUDUL SKRIPSI :

Telah disetujui untuk dipertahankan di hadapan dewan penguji.

Malang, .......................20..

Pembimbing I, Pembimbing II,

_____________________ ______________________