mohon, pada bapak/ibu promotor (yang mewakili) nilai dan...

BERKAS EVALUASI PROPOSAL DISERTASI

N a m a : ................................................................................

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

Program Doktor : ................................................................................

Kekhususan : ................................................................................

Judul Disertasi :

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

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

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

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

Tim Promotor dan Penguji

Promotor : ..................................................................................................................

Ko Promotor 1 : ..................................................................................................................

Ko Promotor 2 : ..................................................................................................................

Penguji 1 : ..................................................................................................................

Penguji 2 : ..................................................................................................................

Penguji 3 : ..................................................................................................................

Dilaksanakan pada:

Hari / Tanggal : .................................... / ...............................

J a m /Tempat : .................................... / ...............................

Kelengkapan Persayaratan yang diserahkan ke Pengajaran

UEPS3-1 = 1 lembar

UEPS-3 = 2 lembar

UEPS-5 = 1 lembar

UEPS-6 dan Saran = 6 lembar

UEPS-7 = 1 lembar

Laporan Kemajuan Belajar = 1 lembar (Asli)

Salinan PAT = 1 lembar

Salinan Toefl = 1 lembar

Salinan TPA = 1 lembar

Tembusan :

1. Ketua Program Doktor = Copy UEPS3-3 = 1 Lembar

2. Bagian Keuangan = Copy UEPS3-3 = 1 Lembar

3. Bagian TU = Copy UEPS3-3 = 1 Lembar

3. Bagian Pengajaran = Copy UEPS3-3 = 1 Lembar

Catatan:

BERKAS UJIAN PROPOSAL DISERTASI DISERAHKAN KEBAGIAN PENGAJARAN PALING

LAMBAT SATU (1) MINGGU SEBELUM PELAKSANAAN UJIAN PROPOSAL

Mohon, pada Bapak/Ibu Promotor (yang mewakili) Nilai dan Berita Acara Ujian Proposal Disertasi Langsung Diserahkan Kebagian Pengajaran (Mohon tidak diserahkan Ke Mahasiswa)

Bagian Pengajaran

KEMENTERIAN RISET, TEKNOLOGI DAN PENDIDIKAN TINGGI

UNIVERSITAS BRAWIJAYA

FAKULTAS TEKNIK

JURUSAN TEKNIK SIPIL

PROGRAM DOKTOR

KARTU KENDALI PERSYARATAN PENDAFTARAN

UJIAN PROPOSAL DISERTASI

Nama Mahasiswa : ..................................................................................

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

Program Doktor : ..................................................................................

Persyaratan Pendaftaran Ujian Proposal Disertasi:

No Jenis Persyaratan Keterangan

1. Naskah Proposal Disertasi yang telah disetujui semua Pembimbing ...................................................

2. Perbanyakan Naskah Proposal Disertasi ..................................................

3. Sertifikat TPA dengan skor telah memenuhi persyaratan Program

Doktor

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

4. Sertifikat TOEFL dengan skor telah memenuhi persyaratan

Program Doktor

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

5. KTM yang masih berlaku ..................................................

6. LKB terakhir dan Hasil Ujian Kualifikasi ..................................................

7. Kartu Rencana Studi ..................................................

8. Bukti Pemenuhan kewajiban administrasi keuangan, dan

administrasi akademik sesuai dengan ketentuan yang berlaku

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

9. Lain-lain, yang dianggap perlu: …………..

Demikian, atas perhatiannya kami ucapkan terimakasih.

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

Sub. Bagian Administrasi Teknik Sipil

( ............................................................................................. )

UEPS3 - 0



FAKULTAS TEKNIK


PROGRAM DOKTOR

Perihal : Permohonan Ujian Proposal Disertasi

Kepada : Yth. Ketua Jurusan Teknik Sipil

Bersama ini kami hadapkan mahasiswa bimbingan kami

N a m a : ..................................................................................

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

Program Doktor : ..................................................................................

Judul Disertasi :

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

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

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

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

Untuk melaksanakan Ujian Proposal Disertasi, dan kami mohon untuk diselenggarakan pada:

H a r i : ..................................................................................

Tanggal : ..................................................................................

J a m : ..................................................................................

Tempat/Ruang : ..................................................................................

Demikian, atas perhatiannya kami ucapkan terima kasih.

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

Promotor,

.................................................... NIP.

UEPS3 - 1



FAKULTAS TEKNIK


PROGRAM DOKTOR

Nomor : /UN10.6.1/AK/2016

Lampiran : 1 (Satu) Berkas

Perihal : Usulan Dosen Penguji Proposal Disertasi

Kepada : Yth. Ketua Jurusan Teknik Sipil

Di Tempat

Sehubungan dengan Ujian Proposal Disertasi mahasiswa:

N a m a : ..................................................................................

No. Mahasiswa : ..................................................................................

Program Doktor : ..................................................................................

Judul Disertasi :

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

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

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

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

maka kami usulkan Dosen Penguji Proposal Disertasi untuk dapat diterbitkan Surat Keputusan Dekan Fakukltas

Teknik.

No. Nama Bidang Keahlian Instansi Asal

1. ........................................................................................ ............................ .............................

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

3. ........................................................................................ ............................ .............................

4. ........................................................................................ ............................ .............................

Demikian, atas perhatian dan kerjasamanya diucapkan terima kasih.

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

Promotor

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

NIP.

UEPS3 - 2



FAKULTAS TEKNIK


PROGRAM DOKTOR

PERSETUJUAN EVALUASI PROPOSAL PENELITIAN DISERTASI

Yang bertanda tangan dibawah ini, tim Promotor dan Penguji menyetujui Ujian Proposal Disertasi mahasiswa :

N a m a : .....................................................................

No. Mahasiswa : .....................................................................

Kekhususan : .....................................................................

Judul : .....................................................................

yang akan diselenggarakan pada :

Hari / Tanggal : .................................... / ...............................

J a m /Tempat : .................................... / ...............................

Kekhususan : .................................... ................................

Judul : .................................... ................................

No. Nama Promotor dan Penguji Tanda tangan Tgl. Persetujuan

1. Promotor

2. Ko- 1

3. Ko- 2

4. Penguji

5. Penguji

6. Penguji

Malang,

Menyetujui

A.n. Ketua Jurusan Teknik Sipil

Ketua Progam Doktor Teknik Sipil,

( .............................................................................. )

Tembusan:

1. Ketua Program Doktor Teknik Sipil

2. Bagian Administrasi Teknik Sipil

3. Bagian Keuangan FT-UB

UEPS3 - 3



FAKULTAS TEKNIK


PROGRAM DOKTOR

Nomor : /UN10.6.1/AK/2016

Lampiran : -

Perihal : Undangan Menguji Proposal Disertasi

Kepada : Yth. .......................................................................................

(Promotor)

Bersama ini kami mengharap kehadiran Bapak/Ibu pada Ujian Proposal Disertasi dari :

N a m a : ................................................................................

No. Mahasiswa : ................................................................................

Program Doktor : ................................................................................


H a r i : ................................................................................

Tanggal : ................................................................................

J a m : ................................................................................

Tempat : ................................................................................


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

Ketua Jurusan Teknik Sipil

Ir. Sugeng P. Budio, MS.

NIP. 19610125 198601 1 001

Catatan :

1. Dosen Penguji dimohon memakai dasi

2. Mahasiswa memakai baju putih, berdasi dan bawahan berwarna gelap

UEPS3 - 4 UEPS3 - 4



FAKULTAS TEKNIK


PROGRAM DOKTOR

Nomor : /UN10.6.1/AK/2016

Lampiran : -


Kepada : Yth. ......................................................................................

(Ko-Promotor I)


N a m a : ................................................................................

No. Mahasiswa : ................................................................................

Program Doktor : ................................................................................


H a r i : ................................................................................

Tanggal : ................................................................................

J a m : ................................................................................

Tempat : ................................................................................


Malang,



NIP. 19610125 198601 1 001

Catatan :



UEPS3 - 4 UEPS3 - 4



FAKULTAS TEKNIK


PROGRAM DOKTOR

Nomor : /UN10.6.1/AK/2016

Lampiran : -


Kepada : Yth. ......................................................................................

(Ko-Promotor II)


N a m a : ................................................................................

No. Mahasiswa : ................................................................................

Program Doktor : ................................................................................


H a r i : ................................................................................

Tanggal : ................................................................................

J a m : ................................................................................

Tempat : ................................................................................


Malang,



NIP. 19610125 198601 1 001

Catatan :



UEPS3 - 4 UEPS3 - 4



FAKULTAS TEKNIK


PROGRAM DOKTOR

Nomor : /UN10.6.1/AK/2016

Lampiran : -


Kepada : Yth. ......................................................................................

(Penguji I)


N a m a : ................................................................................

No. Mahasiswa : ................................................................................

Program Doktor : ................................................................................


H a r i : ................................................................................

Tanggal : ................................................................................

J a m : ................................................................................

Tempat : ................................................................................


Malang,



NIP. 19610125 198601 1 001

Catatan :



UEPS3 - 4 UEPS3 - 4



FAKULTAS TEKNIK


PROGRAM DOKTOR

Nomor : /UN10.6.1/AK/2016

Lampiran : -


Kepada : Yth. ......................................................................................

(Penguji II)


N a m a : ................................................................................

No. Mahasiswa : ................................................................................

Program Doktor : ................................................................................


H a r i : ................................................................................

Tanggal : ................................................................................

J a m : ................................................................................

Tempat : ................................................................................


Malang,



NIP. 19610125 198601 1 001

Catatan :



UEPS3 - 4 UEPS3 - 4



FAKULTAS TEKNIK


PROGRAM DOKTOR

Nomor : /UN10.6.1/AK/2016

Lampiran : -


Kepada : Yth. ......................................................................................

(Penguji III)


N a m a : ................................................................................

No. Mahasiswa : ................................................................................

Program Doktor : ................................................................................


H a r i : ................................................................................

Tanggal : ................................................................................

J a m : ................................................................................

Tempat : ................................................................................


Malang,



NIP. 19610125 198601 1 001

Catatan :



UEPS3 - 4 UEPS3 - 4

KEMENTERIAN RISET, TEKNOLOGI DAN PENDIDIKAN TINGGI UNIVERSITAS BRAWIJAYA

FAKULTAS TEKNIK


PROGRAM DOKTOR

TATACARA PELAKSANAAN EVALUASI PROPOSAL PENELITIAN DISERTASI

1. Mahasiswa diperbolehkan menempuh Ujian Proposal Disertasi bilamana telah memenuhi persyaratan

akademik dan administratif. Mahasiswa S3 telah menempuh minimum 12 sks dengan IPK 3.00 tanpa nilai

D.

2. Tim penguji terdiri dan Tim Promotor ditambah tiga penguji diluar komisi yang ditetapkan oleh Ketua

Jurusan Teknik Sipil berdasarkan usulan Ketua Program Doktor Teknik Sipil.

3. Jadwal ujian ditentukan oleh Ketua Program Doktor PMD Teknik Sipil berdasarkan kesediaan tim penguji

dan kesepakatan dengan mahasiswa.

4. Ujian Proposal Disertasi dilaksanakan sekitar 120 menit dan dipimpin oleh Promotor; jika Promotor tidak

hadir dapat digantikan oleh Ko-Promotor, ujian dapat diselenggarakan jika dihadiri minimum lima orang

penguji.

5. Penilaian ujian meliputi penguasaan materi proposal penelitian disertasi meliputi :

a. Penguasaan metodologi penelitian di bidang ilmunya;

b. Penguasaan materi bidang ilmunya baik yang bersifat dasar maupun kekhususan;

c. Kemampuan penalaran termasuk kemampuan untuk mengadakan abstraksi;

d. Kemampuan sistematisasi dan perumusan hasil pemikiran.

6. Setelah ujian selesai, mahasiswa dipersilahkan keluar ruangan, tim Evaluasi mengadakan rapat untuk

memutuskan hasil ujian.

7. Pada prinsipnya hasil Ujian Proposal Disertasi ditetapkan secara musyawarah oleh tim Penguji; untuk

membantu pengambilan keputusan akhir, penguji mengisi formulir penilaian yang telah disediakan, dan

kemudian diambil nilai reratanya.

Hasil Ujian Proposal Disertasi berupa:

a. Lulus jika hasil rerata ujian proposal penelitian Disertasi minimum B.

b. Tidak lulus*) jika hasil rerata ujian proposal penelitian Disertasi di bawah B.

8. Hasil keputusan penilaian disampaikan pada mahasiswa setelah rapat selesai.

9. Blanko penilaian dan semua berkas dikembalikan ke bagian pengajaran oleh Ketua Tim Penguji dan tidak

diberikan kepada mahasiswa.

Malang,

Ketua Jurusan Teknik Sipil,

ttd.


NIP. 19610125 198601 1 001

Catatan :

*) Bagi yang tidak lulus ulangan ujian proposal disertasi diselenggarakan paling cepat 1 bulan setelah ujian

pertama.

UEPS3 - 5 UEPS3 - 0



FAKULTAS TEKNIK


PROGRAM DOKTOR

NILAI PROPOSAL DISERTASI

N a m a : ................................................................................

No. Mahasiswa : ................................................................................

Program Doktor : ................................................................................

Judul Disertasi : ...............................................................................................................................

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

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

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

No KOMPONEN PENILAIAN Bobot NILAI

(ANGKA)

B x NA

1.

Penguasaan substansi keilmuan dan kemampuan mahasiswa

mengajukan argumentasi ilmiah dalam menjawab pertanyaan

0.30 ............. .......................

2.

Penguasaan metode penelitian dan kemampuan mahasiswa


0.30 ............. .......................

3.

Kemampuan mahasiswa menyajikan/mengkomunikasikan

materi proposalnya

0.20

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

4. Penulisan Proposal Disertasi

0.20 ............. .......................

Jumlah 1.0 .......................

Demikian, untuk menjadikan periksa adanya dan atas perhatiannya kami ucapkan terimakasih

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

Promotor,

( ...................................................................................................... )

Nilai Angka Nilai Huruf Bobot

>80 - 100

> 75 - 80

> 69 - 75

> 60 - 69

> 55 - 60

> 50 - 55

> 44 - 50

0 - 44

A

B+

B

C+

C

D+

D

E

4.0

3.5

3.0

2.5

2.0

1.5

1.0

0

UEPS3 - 6 UEPS3 - 6



FAKULTAS TEKNIK


PROGRAM DOKTOR

N a m a : ................................................................................

No. Mahasiswa : ................................................................................

Program Doktor : ................................................................................

Judul Disertasi : ...............................................................................................................................

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

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

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

saran-saran yang disepakati untuk memperbaiki Disertasinya:

Saran-Saran Perbaikan

1. ............................................................................................................................................................

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

3. ............................................................................................................................................................

4. ............................................................................................................................................................

5. ............................................................................................................................................................

6. ............................................................................................................................................................

7. ............................................................................................................................................................

8. ............................................................................................................................................................

9. ............................................................................................................................................................

10. ............................................................................................................................................................

Demikian, untuk menjadikan periksa adanya dan atas perhatiannya kami ucapkan terimakasih.

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

Promotor,

( ...................................................................................................... )



FAKULTAS TEKNIK


PROGRAM DOKTOR


N a m a : ................................................................................

No. Mahasiswa : ................................................................................

Program Doktor : ................................................................................

Judul Disertasi : ...............................................................................................................................

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

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

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


(ANGKA)

B x NA

1.



0.30 ............. .......................

2.



0.30 ............. .......................

3.


materi proposalnya

0.20

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

4.

Penulisan Proposal Disertasi

0.20 ............. .......................

Jumlah 1.0 .......................


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

Ko-Promotor 1,

( ...................................................................................................... )


>80 - 100

> 75 - 80

> 69 - 75

> 60 - 69

> 55 - 60

> 50 - 55

> 44 - 50

0 - 44

A

B+

B

C+

C

D+

D

E

4.0

3.5

3.0

2.5

2.0

1.5

1.0

0

UEPS3 - 6



FAKULTAS TEKNIK


PROGRAM DOKTOR

N a m a : ................................................................................

No. Mahasiswa : ................................................................................

Program Doktor : ................................................................................

Judul Disertasi : ...............................................................................................................................

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

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

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



1. ............................................................................................................................................................

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

3. ............................................................................................................................................................

4. ............................................................................................................................................................

5. ............................................................................................................................................................

6. ............................................................................................................................................................

7. ............................................................................................................................................................

8. ............................................................................................................................................................

9. ............................................................................................................................................................

10. ............................................................................................................................................................


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

Ko-Promotor 1,

( ...................................................................................................... )



FAKULTAS TEKNIK


PROGRAM DOKTOR


N a m a : ................................................................................

No. Mahasiswa : ................................................................................

Program Doktor : ................................................................................

Judul Disertasi : ...............................................................................................................................

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

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

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


(ANGKA)

B x NA

1.



0.30 ............. .......................

2.



0.30 ............. .......................

3.


materi proposalnya

0.20

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


0.20 ............. .......................

Jumlah 1.0 .......................


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

Ko-Promotor 2,

( ...................................................................................................... )


>80 - 100

> 75 - 80

> 69 - 75

> 60 - 69

> 55 - 60

> 50 - 55

> 44 - 50

0 - 44

A

B+

B

C+

C

D+

D

E

4.0

3.5

3.0

2.5

2.0

1.5

1.0

0

UEPS3 - 6



FAKULTAS TEKNIK


PROGRAM DOKTOR

N a m a : ................................................................................

No. Mahasiswa : ................................................................................

Program Doktor : ................................................................................

Judul Disertasi : ...............................................................................................................................

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

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

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



1. ............................................................................................................................................................

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

3. ............................................................................................................................................................

4. ............................................................................................................................................................

5. ............................................................................................................................................................

6. ............................................................................................................................................................

7. ............................................................................................................................................................

8. ............................................................................................................................................................

9. ............................................................................................................................................................

10. ............................................................................................................................................................


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

Ko-Promotor 2,

( ...................................................................................................... )



FAKULTAS TEKNIK


PROGRAM DOKTOR


N a m a : ................................................................................

No. Mahasiswa : ................................................................................

Program Doktor : ................................................................................

Judul Disertasi : ...............................................................................................................................

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

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

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


(ANGKA)

B x NA

1.



0.30 ............. .......................

2.



0.30 ............. .......................

3.


materi proposalnya

0.20

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


0.20 ............. .......................

Jumlah 1.0 .......................


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

Penguji 1,

( ...................................................................................................... )


>80 - 100

> 75 - 80

> 69 - 75

> 60 - 69

> 55 - 60

> 50 - 55

> 44 - 50

0 - 44

A

B+

B

C+

C

D+

D

E

4.0

3.5

3.0

2.5

2.0

1.5

1.0

0

UEPS3 - 6



FAKULTAS TEKNIK


PROGRAM DOKTOR

N a m a : ................................................................................

No. Mahasiswa : ................................................................................

Program Doktor : ................................................................................

Judul Disertasi : ...............................................................................................................................

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

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

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



1. ............................................................................................................................................................

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

3. ............................................................................................................................................................

4. ............................................................................................................................................................

5. ............................................................................................................................................................

6. ............................................................................................................................................................

7. ............................................................................................................................................................

8. ............................................................................................................................................................

9. ............................................................................................................................................................

10. ............................................................................................................................................................


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

Penguji 1,

( ...................................................................................................... )



FAKULTAS TEKNIK


PROGRAM DOKTOR


N a m a : ................................................................................

No. Mahasiswa : ................................................................................

Program Doktor : ................................................................................

Judul Disertasi : ...............................................................................................................................

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

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

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


(ANGKA)

B x NA

1.



0.30 ............. .......................

2.



0.30 ............. .......................

3.


materi proposalnya

0.20

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


0.20 ............. .......................

Jumlah 1.0 .......................


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

Penguji 2,

( ...................................................................................................... )


>80 - 100

> 75 - 80

> 69 - 75

> 60 - 69

> 55 - 60

> 50 - 55

> 44 - 50

0 - 44

A

B+

B

C+

C

D+

D

E

4.0

3.5

3.0

2.5

2.0

1.5

1.0

0



FAKULTAS TEKNIK


PROGRAM DOKTOR

N a m a : ................................................................................

No. Mahasiswa : ................................................................................

Program Doktor : ................................................................................

Judul Disertasi : ...............................................................................................................................

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

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

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



1. ............................................................................................................................................................

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

3. ............................................................................................................................................................

4. ............................................................................................................................................................

5. ............................................................................................................................................................

6. ............................................................................................................................................................

7. ............................................................................................................................................................

8. ............................................................................................................................................................

9. ............................................................................................................................................................

10. ............................................................................................................................................................


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

Penguji 2,

( ...................................................................................................... )



FAKULTAS TEKNIK


PROGRAM DOKTOR


N a m a : ................................................................................

No. Mahasiswa : ................................................................................

Program Doktor : ................................................................................

Judul Disertasi : ...............................................................................................................................

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

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

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


(ANGKA)

B x NA

1.



0.30 ............. .......................

2.



0.30 ............. .......................

3.


materi proposalnya

0.20

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


0.20 ............. .......................

Jumlah 1.0 .......................


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

Penguji 3,

( ...................................................................................................... )


>80 - 100

> 75 - 80

> 69 - 75

> 60 - 69

> 55 - 60

> 50 - 55

> 44 - 50

0 - 44

A

B+

B

C+

C

D+

D

E

4.0

3.5

3.0

2.5

2.0

1.5

1.0

0

UEPS3 - 6



FAKULTAS TEKNIK


PROGRAM DOKTOR

N a m a : ................................................................................

No. Mahasiswa : ................................................................................

Program Doktor : ................................................................................

Judul Disertasi : ...............................................................................................................................

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

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

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



1. ............................................................................................................................................................

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

3. ............................................................................................................................................................

4. ............................................................................................................................................................

5. ............................................................................................................................................................

6. ............................................................................................................................................................

7. ............................................................................................................................................................

8. ............................................................................................................................................................

9. ............................................................................................................................................................

10. ............................................................................................................................................................


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

Penguji 3,

( ...................................................................................................... )



FAKULTAS TEKNIK


PROGRAM DOKTOR

BERITA ACARA

REKAPITULASI NILAI PROPOSAL DISERTASI

Mahasiswa Program Doktor Jurusan Teknik Sipil tersebut dibawah ini :

N a m a :

No. Mahasiswa :

Program Doktor :

telah dilaksanakan pada :

Hari / Tanggal :

J a m /Tempat :

Nilai :

N a m a Nilai

(Angka)

Keterangan *)

Ketua

Anggota

Anggota

Penguji

Penguji

Penguji

Penguji

1. .............................................................................................

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

3. .............................................................................................

4. .............................................................................................

5. ............................................................................................

6. .............................................................................................

7. .............................................................................................

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Rerata ………..

*) Catatan : Lulus/tidak lulus ketentuan ada pada UEPS3-5

Nilai huruf hanya untuk rerata dan didasarkan pada SK Rektor 078/SK/1995


>80 - 100

> 75 - 80

> 69 - 75

> 60 - 69

> 55 - 60

> 50 - 55

> 44 - 50

0 - 44

A

B+

B

C+

C

D+

D

E

4.0

3.5

3.0

2.5

2.0

1.5

1.0

0

*) Coret yang tidak perlu

Malang,

Promotor (atau yang mewakili),

(……………………………………………….)

UEPS3 - 6 UEPS3 - 7



FAKULTAS TEKNIK


PROGRAM DOKTOR

BERITA ACARA

PENYERAHAN NASKAH PROPOSAL DISERTASI YANG TELAH DISETUJUI

OLEH SEMUA DOSEN PEMBIMBING, DAN TELAH

DISYAHKAN OLEH KETUA PROGRAM DOKTOR JURUSAN TEKNIK SIPIL

Pada hari ini: , tanggal : , bertempat di Sub-Bagian Administrasi PMD

Teknik Sipil, Kami:

N a m a : ......................................................................................

No. Mahasiswa : ......................................................................................

Program Doktor : ......................................................................................

MENYERAHKAN SATU EKSEMPLAR NASKAH PROPOSAL DISERTASI

YANG TELAH DISETUJUI/DITANDA-TANGANI OLEH SEMUA KOMISI PEMBIMBING,

DAN TELAH DISAHKAN OLEH KETUA PROGRAM DOKTOR

KEPADA PETUGAS SUB-BAGIAN ADMINISTRASI PMD JURUSAN TEKNIK SIPIL

Demikian, untuk menjadikan periksa adanya.

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

Petugas Sub-Bagian Administrasi Mahasiswa

(............................................ ) ( ................................................................. )

Catatan: Lembar ini untuk Sub-Bagian Administrasi Jurusan Teknik Sipil

mohon, pada bapak/ibu promotor (yang mewakili) nilai dan...

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