Gedung B.J. Habibie Lt. 11, Jalan M.H. Thamrin Nomor 8, Jakarta Pusat 10340
Surel dirtalenta@brin.go.id , Laman: https://www.brin.go.id
NOTA DINAS
NOMOR B-893/II.5.4/DL.01.01/5/2023
Demikian kami sampaikan. Atas perhatian dan kerjasamanya, kami ucapkan terima
kasih.
Tembusan:
1. Deputi Bidang SDM Iptek BRIN
2. Sekretaris Deputi Bidang SDM Iptek BRIN
KOP SURAT SATUAN KERJA
Nama : ................................................................................................................
NIP/NIK : ................................................................................................................
No.HP : ................................................................................................................
Alamat Rumah : ................................................................................................................
E-mail : ................................................................................................................
Satuan Kerja Asal : ................................................................................................................
Instansi : ................................................................................................................
Bidang Kepakaran/Kel. Penelitian : ................................................................................................................
Perguruan Tinggi Tempat Studi : ................................................................................................................
Jenjang : S2 / S3 (pilih salah satu)
Fakultas : ................................................................................................................
Program Studi : ................................................................................................................
NIM : ................................................................................................................
TMT Kuliah (Bulan/Tahun) : ................................................................................................................
Pembimbing Utama (Promotor) : ................................................................................................................
Pembimbing Pendamping (Co Promotor) : ................................................................................................................
Topik/Judul Proposal : ................................................................................................................
................................................................................................................
I. KEMAJUAN STUDI
Indeks Prestasi Akademik semester ini : ................................................................................................................
Pencapaian target akademik setiap semester sesuai dengan kurikulum jalur riset pada perguruan tinggi:
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Rencana akademik pada semester berikutnya:
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………………, ………………………………..
Yang Melaporkan,
Pembimbing Pendamping,
Ttd
Ttd
Nama
Nama NIP.
NIP.