Form Pendaftaran Ujian TA ku
10
Rekening Pembayaran TA : No. Rek: 0039649508 Nama : Rektor UBM S1 Non UT/FK Bank : BNI ‘46 KBI : Rp. 400.000,- (Malaysia) Reguler : Rp. 300.000,- KEMENTERIAN PENDIDIKAN DAN KEBUDAYAAN UNIVERSITAS BRAWIJAYA FAKULTAS KEDOKTERAN Jalan Veteran Malang – 65145, Jawa Timur - Indonesia Telp. (0341) 551611 Pes. 213.214; 569117, 567192 – Fax. (62) (0341) 564755 Form TA 05 FORMULIR PENDAFTARAN UJIAN SARJANA Nama : ............................................... ..................................... N I M : ......................................................... Program Studi : PD / Keperawatan / Gizi / PD. Gigi / Kebidanan / Farmasi Tempat / Tgl Lahir : .............................................................. ....................... Agama : .......................................... ............... Jenis Kelamin : Laki-laki / Perempuan Status Perkawinan : ......................................................... Alamat Di Malang : .............................................................. ......................................... ............................................... ........................................................ Nama Orang Tua : .............................................................. ........................ Pekerjaan Orang Tua : .............................................................. ........................ Tahun Masuk Fakultas : ......................................................... Terminal : ............... smt (smt .................... th ....................... / ....................) Judul Tugas Akhir : .............................................................. ......................................... ............................................... ........................................................ ............................................... ........................................................ Dosen Pembimbing : 1. .................................................................. ................ 2. .................................................................. ................ Selesai Penulisan : ..................................... bulan Persyaratan Pendaftaran :
-
Upload
uzzy-lintang-savitri -
Category
Documents
-
view
215 -
download
1
description
jhlkfutkdku
Transcript of Form Pendaftaran Ujian TA ku
Rekening Pembayaran TA : No. Rek: 0039649508Nama : Rektor UBM S1 Non UT/FKBank : BNI ‘46KBI : Rp. 400.000,- (Malaysia)Reguler : Rp. 300.000,-SAP : Rp. 350.000,-
KEMENTERIAN PENDIDIKAN DAN KEBUDAYAANUNIVERSITAS BRAWIJAYA
FAKULTAS KEDOKTERANJalan Veteran Malang – 65145, Jawa Timur - Indonesia
Telp. (0341) 551611 Pes. 213.214; 569117, 567192 – Fax. (62) (0341) 564755e-mail : [email protected] http://www.fk.ub.ac.id
Form TA 05
FORMULIR PENDAFTARAN UJIAN SARJANA
Nama : ....................................................................................N I M : .........................................................Program Studi : PD / Keperawatan / Gizi / PD. Gigi / Kebidanan / FarmasiTempat / Tgl Lahir : .....................................................................................Agama : .........................................................Jenis Kelamin : Laki-laki / PerempuanStatus Perkawinan : .........................................................Alamat Di Malang : .......................................................................................................
.......................................................................................................Nama Orang Tua : ......................................................................................Pekerjaan Orang Tua : ......................................................................................Tahun Masuk Fakultas : .........................................................Terminal : ............... smt (smt .................... th ....................... / ....................)Judul Tugas Akhir : .......................................................................................................
....................................................................................................... .......................................................................................................
Dosen Pembimbing : 1. .................................................................................. 2. ..................................................................................
Selesai Penulisan : ..................................... bulan
Persyaratan Pendaftaran:
1. Fotocopy Kartu Tanda Mahasiswa (KTM) semester terakhir (1 lembar)2. Kuitansi asli pembayaran Tugas Akhir (Pembayaran di Bank BNI) di Fotocopy 1x3. Lembar Konsultasi asli (Form TA 04) manimal 10x bimbingan untuk masing-masing dosen4. Pas photo ukuran 3 x 4 berwarna menggunakan almamater sebanyak 1 lembar (Tulis nama & NIM
dibelakang foto)5. Lembar Persetujuan Ujian Tugas Akhir (Form TA 07) di Fotocopy 1x6. Formulir Bebas Tanggungan Laboratorium (Form TA 06)7. Lembar Bukti Pendaftaran Tugas Akhir8. Map bufalo warna hijau (PD), kuning (PSIK), biru (PSIG), pink (PSPDG & PS.Kebidanan), sebanyak 4
lembar9. Lembar Persetujuan yang ditandatangani kedua Pembimbing sebanyak (1 lembar) 10. Foto Copy KHS terakhir (1 lembar)11. Printout KRS online terakhir (1 lembar)12. Naskah TA (1 eksemplar)13. Lembar bukti kelayakan etik (1 lembar)14. Form penilaian Log Book (dari dua dosen pembimbing)
Malang, ......................................
Koord. / Wakil Koord. TA Mahasiswa,
................................................. ..................................................NIP. NIM.
“ Semua Persyaratan Ujian TA minimal 1 Minggu sebelum ujian berlangsung harus sudah terkumpul ke Petugas TA”
KEMENTERIAN PENDIDIKAN DAN KEBUDAYAANUNIVERSITAS BRAWIJAYA
FAKULTAS KEDOKTERANJalan Veteran Malang – 65145, Jawa Timur - Indonesia
Telp. (0341) 551611 Pes. 213.214; 569117, 567192 – Fax. (62) (0341) 564755e-mail : [email protected] http://www.fk.ub.ac.id
Form TA 06
FORMULIR BEBAS TANGGUNGAN LABORATORIUM
Nama : ......................................................................................................N I M : .............................................................Judul Penelitian :..........................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................Dosen Pembimbing :
1. ...................................................................................................2. ...................................................................................................
Nama LaboratoriumTanda Tangan
(Nama Terang Penanggung Jawab &Stampel Lab.)
FARMAKOLOGI
MIKROBIOLOGI
PARASITOLOGI
BIOMEDIK
PATOLOGI ANATOMI
PATOLOGI KLINIK
.................................................
.................................................
Malang, ................................................
Koord. / Wakil Koord. TA,
......................................................NIP.
KEMENTERIAN PENDIDIKAN DAN KEBUDAYAANUNIVERSITAS BRAWIJAYA
FAKULTAS KEDOKTERANJalan Veteran Malang – 65145, Jawa Timur - Indonesia
Telp. (0341) 551611 Pes. 213.214; 569117, 567192 – Fax. (62) (0341) 564755e-mail : [email protected] http://www.fk.ub.ac.id
Form TA 07
PERSETUJUAN UJIAN TUGAS AKHIR
Nama : ..................................................................................................
N I M : ................................................................
No. Telp. / HP : ................................................................
Program Studi : PD / Keperawatan / Gizi / PD. Gigi / Kebidanan / Farmasi
Judul : ..................................................................................................................
..................................................................................................................
..................................................................................................................
..................................................................................................................
Hari : ................................................................
Tanggal : ................................................................
Jam : ................................................................
Ruangan : ................................................................ (Diisi Petugas TA)
Penguji :
No Penguji Nama & NIP
Golongan &Pangkat
TandaTangan
1 Penguji 1
2 Penguji 2 /Pembimbing 1
3 Penguji 3 /Pembimbing 2
Malang, ................................................
Mahasiswa,
............................................................NIM.
KEMENTERIAN PENDIDIKAN DAN KEBUDAYAANUNIVERSITAS BRAWIJAYA
FAKULTAS KEDOKTERANJalan Veteran Malang – 65145, Jawa Timur - Indonesia
Telp. (0341) 551611 Pes. 213.214; 569117, 567192 – Fax. (62) (0341) 564755e-mail : [email protected] http://www.fk.ub.ac.id
Pembimbing 1
BORANG PENILAIAN LOG BOOK TUGAS AKHIR MAHASISWA FKUB
NAMA MAHASISWA : ..................................................................................................................
NIM : ..................................................................................................................
NAMA PEMBIMBING 1 : .................................................................................(*coret yang tidak perlu)
JUDUL TUGAS AKHIR :
...................................................................................................................................................................
...................................................................................................................................................................
...................................................................................................................................................................
...................................................................................................................................................................
....
No.(a)
KRITERIA PENILAIAN(b)
BOBOT(c)
SKOR(1 – 100)(d)
NILAI(c x d)
1. Orisinalitas (Karya Sendiri) 30%
2. Kesesuaian Data dengan Tujuan Penelitian
30%
3. Kelengkapan Data dan Fakta 20%
4. Kerapian log book 10%
5. Sistematika (runtut) 10%
TOTAL NILAI 100%
Malang, …………………………………………
Mengetahui,Pembimbing 1,
(……………………………………………………)
KEMENTERIAN PENDIDIKAN DAN KEBUDAYAANUNIVERSITAS BRAWIJAYA
FAKULTAS KEDOKTERANJalan Veteran Malang – 65145, Jawa Timur - Indonesia
Telp. (0341) 551611 Pes. 213.214; 569117, 567192 – Fax. (62) (0341) 564755e-mail : [email protected] http://www.fk.ub.ac.id
Pembimbing 2
BORANG PENILAIAN LOG BOOK TUGAS AKHIR MAHASISWA FKUB
NAMA MAHASISWA : ..................................................................................................................
NIM : ..................................................................................................................
NAMA PEMBIMBING 2 : .................................................................................(*coret yang tidak perlu)
JUDUL TUGAS AKHIR :
...................................................................................................................................................................
...................................................................................................................................................................
...................................................................................................................................................................
...................................................................................................................................................................
....
No.(a)
KRITERIA PENILAIAN(b)
BOBOT(c)
SKOR(1 – 100)(d)
NILAI(c x d)
1. Orisinalitas (Karya Sendiri) 30%
2. Kesesuaian Data dengan Tujuan Penelitian
30%
3. Kelengkapan Data dan Fakta 20%
4. Kerapian log book 10%
5. Sistematika (runtut) 10%
TOTAL NILAI 100%
Malang, …………………………………………
Mengetahui,Pembimbing 2,
(……………………………………………………)
