KEMENTERIAN PENDIDIKAN, KEBUDAYAAN,

RISET, DAN TEKNOLOGI

UNIVERSITAS SUMATERA UTARA
FAKULTAS PERTANIAN
PROGRAM STUDI AGRIBISNIS
Jalan. Prof. A. Sofyan No. 3 Kampus USU Medan - 20155
Telp. 061 - 8213236 Fax. : 061 - 8211924

FORMULIR PENDAFTARAN SEMINAR HASIL PENELITIAN

Nama : ............................................................................................................
..............................................................................................................
NIM : ............................................................................................................
Program Studi : ............................................................................................................
Tempat/Tanggal Lahir..............................................................................................................:
Alamat/Telepon/HP : ............................................................................................................
Judul Penelitian : ............................................................................................................
............................................................................................................
Tanggal Acc : .........................................

Komisi Pembimbing
1. Ketua : ................................................................ NIP ..................................
2. Anggota : ................................................................ NIP ..................................

Waktu Pelaksanaan *)...........................................................................................................

Hari/Tanggal : ............................................................................................................
Pukul : ............................................................................................................
Tempat : ............................................................................................................

Mengetahui,
Komisi Pembimbing,
Ketua, Anggota,

(........................................................) (........................................................)
NIP. NIP.

Medan,
Yang Mendaftar,

(.............................................)
NIM.

*) : - Pelaksanaan Seminar Dilaksanakan Minimal 4 (Empat) Hari Setelah Acc

- Menjadi pembahas utama harus yang sudah keluar dosen pembimbingnya
KESEDIAAN MENJADI PEMBAHAS UTAMA
SEMINAR HASIL PENELITIAN

Nama : ............................................................................................................
NIM : ............................................................................................................
Program Studi : ............................................................................................................
Tempat/Tanggal Lahir..............................................................................................................:
Alamat/Telepon/HP : ............................................................................................................
 KEMENTERIAN PENDIDIKAN, KEBUDAYAAN,
RISET, DAN TEKNOLOGI
UNIVERSITAS SUMATERA UTARA
FAKULTAS PERTANIAN
PROGRAM STUDI AGRIBISNIS
Jalan. Prof. A. Sofyan No. 3 Kampus USU Medan - 20155
Telp. 061 - 8213236 Fax. : 061 - 8211924

............................................................................................................
Judul Penelitian : ............................................................................................................
.............................................................................................................
No Nama Mahasiswa NIM T. Tangan
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
Mengetahui,
Komisi Pembimbing,
Ketua, Anggota,

(...............................................) (...............................................)
NIP. NIP.