Form TA 09

FORMULIR PENDAFTARAN UJIAN SIDANG TUGAS AKHIR

Nama : ....................................................................................
NIM : .........................................................
Program Studi : S1 Kebidanan
Tempat / Tgl Lahir : .....................................................................................
Agama : .........................................................
Jenis Kelamin : Perempuan
Alamat Di Malang : .......................................................................................................
.......................................................................................................
Nama Orang Tua : ......................................................................................
Pekerjaan Orang Tua : ......................................................................................
Tahun Masuk Fakultas : .........................................................
Judul Tugas Akhir :
.......................................................................................................
.......................................................................................................
.......................................................................................................
Dosen Pembimbing : 1. ..................................................................................
2. ..................................................................................
Selesai Pelaksanaan &
Penulisan : ..................................... bulan

Persyaratan Pendaftaran:
1. Pas photo ukuran 3 x 4 berwarna menggunakan almamater sebanyak 1 lembar (Tulis nama & NIM
dibelakang foto)
2. Fotocopy Kartu Tanda Mahasiswa (KTM) semester terakhir (1 lembar)
3. Lembar Persetujuan Ujian Tugas Akhir (Form TA 08)
4. Form penilaian Log Book (dari dua dosen pembimbing)
5. Lembar Konsultasi asli untuk Tim TA yang fotocopy untuk diberikan ke Pembimbing (Form TA 04) (minimal
8x bimbingan untuk masing-masing dosen)
6. Formulir Bebas Tanggungan Laboratorium (Form TA 07)
7. Formulir pendaftaran Ujian Sidang Tugas Akhir (Form TA 09)
8. Lembar Persetujuan yang ditandatangani kedua Pembimbing sebanyak (1 lembar)
9. Foto Copy KHS terakhir (1 lembar)
10. Printout KRS online terakhir (1 lembar)
11. Lembar bukti kelayakan etik (1 lembar)
12. Lembar Bukti Pendaftaran Tugas Akhir
13. Softcopy pdf naskah TA (1 eksemplar) dengan lembar persetujuan yang sudah ditandatangani kedua dosen
pembimbing.

Malang, ......................................

Koordinator Tugas Akhir Kebidanan, Mahasiswa,

................................................. ..................................................
NIP. NIM.
*) coret yang tidak perlu
 Form TA 07

FORMULIR BEBAS TANGGUNGAN LABORATORIUM

Nama : ......................................................................................................
NIM : .............................................................
Program Studi : S1 Kebidanan
Judul Penelitian :
....................................................................................................................................................................
....................................................................................................................................................................
....................................................................................................................................................................
..............................................................................................................................................................
Dosen Pembimbing :
1. ...................................................................................................
2. ...................................................................................................

Tanda Tangan
Nama Laboratorium (Nama Terang Penanggung Jawab &
Stampel Lab.)

BIOMEDIK

FISIOLOGI

FARMAKOLOGI

MIKROBIOLOGI

PARASITOLOGI

PATOLOGI ANATOMI

PATOLOGI KLINIK

.................................................

Malang, ................................................

Koordinator TA Kebidanan,

......................................................
NIP.
 Form TA 08

PERSETUJUAN UJIAN TUGAS AKHIR

Nama : ..................................................................................................
NIM : ................................................................
No. Telp. / HP : ................................................................
Program Studi : S1 Kebidanan
Judul : ..................................................................................................................
..................................................................................................................
..................................................................................................................
..................................................................................................................

Hari : ................................................................
Tanggal : ................................................................
Jam : ................................................................
Ruangan : ................................................................

Penguji :
Nama & Golongan & Tanda
No Penguji
NIP Pangkat Tangan

1 Penguji 1

2 Penguji 2 /
Pembimbing 1

3 Penguji 3 /
Pembimbing 2

Malang, ................................................
Mahasiswa,

............................................................
NIM.
 Pembimbing 1

BORANG PENILAIAN LOG BOOK TUGAS AKHIR

MAHASISWA FKUB

NAMA MAHASISWA : ..................................................................................................................

NIM : ..................................................................................................................
NAMA PEMBIMBING 1 : .................................................................................(*coret yang tidakperlu)
JUDUL TUGAS AKHIR :
....................................................................................................................................................................
....................................................................................................................................................................
....................................................................................................................................................................
....................................................................................................................................................................

No. KRITERIA PENILAIAN BOBOT SKOR (1 – 100) NILAI

(a) (b) (c) (d) (c x d)
1. Orisinalitas (Karya Sendiri) 30%

2. Kesesuaian Data dengan Tujuan 30%

Penelitian
3. Kelengkapan Data dan Fakta 20%

4. Kerapian log book 10%

5. Sistematika (runtut) 10%

TOTAL NILAI 100%

Malang,
…………………………………………

Mengetahui,
Pembimbing1,

(……………………………………………………)
 Pembimbing 2

BORANG PENILAIAN LOG BOOK TUGAS AKHIR

MAHASISWA FKUB

NAMA MAHASISWA : ..................................................................................................................

NIM : ..................................................................................................................
NAMA PEMBIMBING 2 : .................................................................................(*coret yang tidakperlu)
JUDUL TUGAS AKHIR :
....................................................................................................................................................................
....................................................................................................................................................................
....................................................................................................................................................................
....................................................................................................................................................................

No. KRITERIA PENILAIAN BOBOT SKOR (1 – 100) NILAI

(a) (b) (c) (d) (c x d)
1. Orisinalitas (Karya Sendiri) 30%

2. Kesesuaian Data dengan Tujuan 30%

Penelitian
3. Kelengkapan Data dan Fakta 20%

4. Kerapian log book 10%

5. Sistematika (runtut) 10%

TOTAL NILAI 100%

Malang,
…………………………………………

Mengetahui,
Pembimbing2,

(……………………………………………………)