Page 1
IDENTITAS PESERTA BIMBINGAN DISERTASI
TAHUN AKDEMIK............/...........
Nama : ................................................................................................................................
NIM : ................................................................................................................................
Program Studi : ................................................................................................................................
Alamat asal/Telp/HP : ................................................................................................................................
................................................................................................................................
................................................................................................................................
Alamat Malang/Telp/HP : ................................................................................................................................
................................................................................................................................
4x6
(berwarna)
Page 2
KEMENTERIAN AGAMA
UNIVERSITAS ISLAM NEGERI MAULANA MALIK IBRAHIM MALANG
PASCASARJANA Jalan Ir. Soekarno No. 34 Dadaprejo Faksimile (0341) 531130Kota Batu 65323, Telepon (0341) 531133
Website: http://pasca.uin-malang.ac.id, Email: [email protected]
No. Dokumen
UIN-QA/PM/14/05 KARTU BIMBINGAN
PROPOSAL DISERTASI
Tanggal Terbit
5 Januari 2016
Revisi
0.00 -
Nama : ......................................................................................................................................
NIM : ......................................................................................................................................
Program Studi : ......................................................................................................................................
Alamat : ......................................................................................................................................
......................................................................................................................................
......................................................................................................................................
No. Tlp dan HP : ......................................................................................................................................
Judul : ......................................................................................................................................
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Tanggal Mulai Bimbingan : ......................................................................................................................................
Pembimbing : 1. ……………………………………………………………………………………………...
2. ……………………………………………………………………………………………...
3. ……………………………………………………………………………………………...
Page 3
PASCASARJANA
Topik Bimbingan:
Tanggal Bimbingan:
Catatan :
Tanda Tangan
Mahasiswa: Promotor:
Topik Bimbingan:
Tanggal Bimbingan:
Catatan :
Tanda Tangan
Mahasiswa: Promotor:
Page 4
PASCASARJANA
Topik Bimbingan:
Tanggal Bimbingan:
Catatan :
Tanda Tangan
Mahasiswa: Promotor:
Topik Bimbingan:
Tanggal Bimbingan:
Catatan :
Tanda Tangan
Mahasiswa: Promotor:
Page 5
PASCASARJANA
Topik Bimbingan:
Tanggal Bimbingan:
Catatan :
Tanda Tangan
Mahasiswa: Promotor:
Topik Bimbingan:
Tanggal Bimbingan:
Catatan :
Tanda Tangan
Mahasiswa: Promotor:
Page 6
PASCASARJANA
Topik Bimbingan:
Tanggal Bimbingan:
Catatan :
Tanda Tangan
Mahasiswa: Promotor:
Topik Bimbingan:
Tanggal Bimbingan:
Catatan :
Tanda Tangan
Mahasiswa: Promotor:
Page 7
PASCASARJANA
Topik Bimbingan:
Tanggal Bimbingan:
Catatan :
Tanda Tangan
Mahasiswa: Promotor:
Topik Bimbingan:
Tanggal Bimbingan:
Catatan :
Tanda Tangan
Mahasiswa: Promotor:
Page 8
PASCASARJANA
Topik Bimbingan:
Tanggal Bimbingan:
Catatan :
Tanda Tangan
Mahasiswa: Promotor:
Topik Bimbingan:
Tanggal Bimbingan:
Catatan :
Tanda Tangan
Mahasiswa: Promotor:
Page 9
PASCASARJANA
Topik Bimbingan:
Tanggal Bimbingan:
Catatan :
Tanda Tangan
Mahasiswa: Promotor:
Topik Bimbingan:
Tanggal Bimbingan:
Catatan :
Tanda Tangan
Mahasiswa: Promotor:
Page 10
PASCASARJANA
Topik Bimbingan:
Tanggal Bimbingan:
Catatan :
Tanda Tangan
Mahasiswa: Promotor:
Topik Bimbingan:
Tanggal Bimbingan:
Catatan :
Tanda Tangan
Mahasiswa: Promotor:
Page 11
PASCASARJANA
Topik Bimbingan:
Tanggal Bimbingan:
Catatan :
Tanda Tangan
Mahasiswa: Promotor:
Topik Bimbingan:
Tanggal Bimbingan:
Catatan :
Tanda Tangan
Mahasiswa: Promotor:
Page 12
PASCASARJANA
Topik Bimbingan:
Tanggal Bimbingan:
Catatan :
Tanda Tangan
Mahasiswa: Promotor:
Topik Bimbingan:
Tanggal Bimbingan:
Catatan :
Tanda Tangan
Mahasiswa: Promotor:
Page 13
KEMENTERIAN AGAMA
UNIVERSITAS ISLAM NEGERI MAULANA MALIK IBRAHIM MALANG
PASCASARJANA Jalan Ir. Soekarno No. 34 Dadaprejo Faksimile (0341) 531130Kota Batu 65323, Telepon (0341) 531133
Website: http://pasca.uin-malang.ac.id, Email: [email protected]
No. Dokumen
UIN-QA/PM/14/05 FORMULIR PENDAFTARAN
UJIAN PROPOSAL DISERTASI
Tanggal Terbit
5 Januari 2016
Revisi
0.00 -
Yang bertanda tangan di bawah ini:
1. Nama Lengkap : .............................................................................................................................................................
2. Tempat & Tgl. Lahir : .............................................................................................................................................................
3. N I M : .............................................................................................................................................................
4. Semester : .............................................................................................................................................................
5. Program Studi : .............................................................................................................................................................
6. Jumlah sks *) : .............................................................................................................................................................
7. Alamat rumah/telepon. : .............................................................................................................................................................
.............................................................................................................................................................
8. Judul Disertasi : .............................................................................................................................................................
.............................................................................................................................................................
9. Promotor : 1. ......................................................................................................................................................
2. ......................................................................................................................................................
3. ......................................................................................................................................................
10. Tanggal Penyerahan** : .............................................................................................................................................................
Mengajukan permohonan untuk didaftar sebagai peserta Ujian Proposal Disertasi pada Semester _____________ Tahun Akademik_______/_______untuk itu sebagai kelengkapan pendaftaran di bawah ini kami lampirkan hal-hal sebagai berikut:
11. Foto copy Transkrip Nilai
12. Pas foto ukuran 3 x 4 berwarna (3 lembar)
13. Foto copy surat keterangan lunas SPP dan herregistrasi
14. Proposal Disertasi dijilid soft cover 6 exemplar (warna merah maron)
15. Semua berkas dimasukkan ke dalam map plastik snelhechter warna merah
Batu,…………………………………………
Pendaftar,
.............................................................. (Nama Terang & Tanda Tangan)
Catatan: *) Jumlah keseluruan sks yang sudah ditempuh dan dinyatakan lulus. **) Di isi oleh petugas pendaftaran ***) Foto Copy Formulir Pendaftaran Ujian Proposal Disertasi ini
Page 14
KEMENTERIAN AGAMA
UNIVERSITAS ISLAM NEGERI MAULANA MALIK IBRAHIM MALANG
PASCASARJANA Jalan Ir. Soekarno No. 34 Dadaprejo Faksimile (0341) 531130Kota Batu 65323, Telepon (0341) 531133
Website: http://pasca.uin-malang.ac.id, Email: [email protected]
No. Dokumen
UIN-QA/PM/14/05 KARTU BIMBINGAN
SEMINAR HASIL PENELITIAN DISERTASI
Tanggal Terbit
5 Januari 2016
Revisi
0.00 -
Nama : ......................................................................................................................................
NIM : ......................................................................................................................................
Program Studi : ......................................................................................................................................
Alamat : ......................................................................................................................................
......................................................................................................................................
......................................................................................................................................
No. Tlp dan HP : ......................................................................................................................................
Judul : ......................................................................................................................................
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Tanggal Mulai Bimbingan : ......................................................................................................................................
Nama Promotor : 1. ……………………………………………………………………………………………...
2. ……………………………………………………………………………………………...
3. ……………………………………………………………………………………………...
Page 15
PASCASARJANA
Topik Bimbingan:
Tanggal Bimbingan:
Catatan :
Tanda Tangan
Mahasiswa: Promotor:
Topik Bimbingan:
Tanggal Bimbingan:
Catatan :
Tanda Tangan
Mahasiswa: Promotor:
Page 16
PASCASARJANA
Topik Bimbingan:
Tanggal Bimbingan:
Catatan :
Tanda Tangan
Mahasiswa: Promotor:
Topik Bimbingan:
Tanggal Bimbingan:
Catatan :
Tanda Tangan
Mahasiswa: Promotor:
Page 17
PASCASARJANA
Topik Bimbingan:
Tanggal Bimbingan:
Catatan :
Tanda Tangan
Mahasiswa: Promotor:
Topik Bimbingan:
Tanggal Bimbingan:
Catatan :
Tanda Tangan
Mahasiswa: Promotor:
Page 18
PASCASARJANA
Topik Bimbingan:
Tanggal Bimbingan:
Catatan :
Tanda Tangan
Mahasiswa: Promotor:
Topik Bimbingan:
Tanggal Bimbingan:
Catatan :
Tanda Tangan
Mahasiswa: Promotor:
Page 19
PASCASARJANA
Topik Bimbingan:
Tanggal Bimbingan:
Catatan :
Tanda Tangan
Mahasiswa: Promotor:
Topik Bimbingan:
Tanggal Bimbingan:
Catatan :
Tanda Tangan
Mahasiswa: Promotor:
Page 20
PASCASARJANA
Topik Bimbingan:
Tanggal Bimbingan:
Catatan :
Tanda Tangan
Mahasiswa: Promotor:
Topik Bimbingan:
Tanggal Bimbingan:
Catatan :
Tanda Tangan
Mahasiswa: Promotor:
Page 21
PASCASARJANA
Topik Bimbingan:
Tanggal Bimbingan:
Catatan :
Tanda Tangan
Mahasiswa: Promotor:
Topik Bimbingan:
Tanggal Bimbingan:
Catatan :
Tanda Tangan
Mahasiswa: Promotor:
Page 22
PASCASARJANA
Topik Bimbingan:
Tanggal Bimbingan:
Catatan :
Tanda Tangan
Mahasiswa: Promotor:
Topik Bimbingan:
Tanggal Bimbingan:
Catatan :
Tanda Tangan
Mahasiswa: Promotor:
Page 23
PASCASARJANA
Topik Bimbingan:
Tanggal Bimbingan:
Catatan :
Tanda Tangan
Mahasiswa: Promotor:
Topik Bimbingan:
Tanggal Bimbingan:
Catatan :
Tanda Tangan
Mahasiswa: Promotor:
Page 24
PASCASARJANA
Topik Bimbingan:
Tanggal Bimbingan:
Catatan :
Tanda Tangan
Mahasiswa: Promotor:
Topik Bimbingan:
Tanggal Bimbingan:
Catatan :
Tanda Tangan
Mahasiswa: Promotor:
Page 25
KEMENTERIAN AGAMA
UNIVERSITAS ISLAM NEGERI MAULANA MALIK IBRAHIM MALANG
PASCASARJANA Jalan Ir. Soekarno No. 34 Dadaprejo Faksimile (0341) 531130Kota Batu 65323, Telepon (0341) 531133
Website: http://pasca.uin-malang.ac.id, Email: [email protected]
No. Dokumen
UIN-QA/PM/14/05 FORMULIR PENDAFTARAN
SEMINAR HASIL PENELITIAN DISERTASI
Tanggal Terbit
5 Januari 2016
Revisi
0.00 -
Yang bertanda tangan di bawah ini:
1. Nama Lengkap : .............................................................................................................................................................
2. Tempat & Tgl. Lahir : .............................................................................................................................................................
3. N I M : .............................................................................................................................................................
4. Semester : .............................................................................................................................................................
5. Program Studi : .............................................................................................................................................................
6. Jumlah sks *) : .............................................................................................................................................................
7. Alamat rumah/telepon. : .............................................................................................................................................................
.............................................................................................................................................................
8. Judul Disertasi : .............................................................................................................................................................
.............................................................................................................................................................
9. Promotor : 1. .......................................................................................................................................................
2. .......................................................................................................................................................
3. .......................................................................................................................................................
10. Tanggal Penyerahan** : .............................................................................................................................................................
Mengajukan permohonan untuk didaftar sebagai peserta Seminar Hasil Penelitian Disertasi pada Semester _____________ Tahun Akademik_______/_______untuk itu sebagai kelengkapan pendaftaran di bawah ini kami lampirkan hal-hal sebagai berikut:
11. Foto copy Transkrip Nilai
12. Pas foto ukuran 3 x 4 berwarna (3 lembar).
13. Foto copy surat keterangan lunas SPP dan herregistrasi
14. Hasil Penelitian Disertasi dijilid soft cover 6 exemplar (warna merah maron)
15. Semua berkas dimasukkan ke dalam map plastik snelhechter warna merah
Batu,…………………………………………
Pendaftar,
.............................................................. (Nama Terang & Tanda Tangan)
Catatan: *) Jumlah keseluruan sks yang sudah ditempuh dan dinyatakan lulus. **) Di isi oleh petugas pendaftaran ***) Foto Copy Formulir Pendaftaran Ujian Proposal Disertasi ini
Page 26
KEMENTERIAN AGAMA
UNIVERSITAS ISLAM NEGERI MAULANA MALIK IBRAHIM MALANG
PASCASARJANA Jalan Ir. Soekarno No. 34 Dadaprejo Faksimile (0341) 531130Kota Batu 65323, Telepon (0341) 531133
Website: http://pasca.uin-malang.ac.id, Email: [email protected]
No. Dokumen
UIN-QA/PM/14/05 KARTU BIMBINGAN
DISERTASI PENDAHULUAN
Tanggal Terbit
5 Januari 2016
Revisi
0.00 -
Nama : ......................................................................................................................................
NIM : ......................................................................................................................................
Program Studi : ......................................................................................................................................
Alamat : ......................................................................................................................................
......................................................................................................................................
......................................................................................................................................
No. Tlp dan HP : ......................................................................................................................................
Judul : ......................................................................................................................................
......................................................................................................................................
......................................................................................................................................
......................................................................................................................................
......................................................................................................................................
......................................................................................................................................
......................................................................................................................................
......................................................................................................................................
......................................................................................................................................
......................................................................................................................................
......................................................................................................................................
......................................................................................................................................
......................................................................................................................................
......................................................................................................................................
Tanggal Mulai Bimbingan : ......................................................................................................................................
Nama Promotor : 1. ……………………………………………………………………………………………...
2. ……………………………………………………………………………………………...
3. ……………………………………………………………………………………………...
Page 27
PASCASARJANA
Topik Bimbingan:
Tanggal Bimbingan:
Catatan :
Tanda Tangan
Mahasiswa: Promotor:
Topik Bimbingan:
Tanggal Bimbingan:
Catatan :
Tanda Tangan
Mahasiswa: Promotor:
Page 28
PASCASARJANA
Topik Bimbingan:
Tanggal Bimbingan:
Catatan :
Tanda Tangan
Mahasiswa: Promotor:
Topik Bimbingan:
Tanggal Bimbingan:
Catatan :
Tanda Tangan
Mahasiswa: Promotor:
Page 29
PASCASARJANA
Topik Bimbingan:
Tanggal Bimbingan:
Catatan :
Tanda Tangan
Mahasiswa: Promotor:
Topik Bimbingan:
Tanggal Bimbingan:
Catatan :
Tanda Tangan
Mahasiswa: Promotor:
Page 30
PASCASARJANA
Topik Bimbingan:
Tanggal Bimbingan:
Catatan :
Tanda Tangan
Mahasiswa: Promotor:
Topik Bimbingan:
Tanggal Bimbingan:
Catatan :
Tanda Tangan
Mahasiswa: Promotor:
Page 31
PASCASARJANA
Topik Bimbingan:
Tanggal Bimbingan:
Catatan :
Tanda Tangan
Mahasiswa: Promotor:
Topik Bimbingan:
Tanggal Bimbingan:
Catatan :
Tanda Tangan
Mahasiswa: Promotor:
Page 32
PASCASARJANA
Topik Bimbingan:
Tanggal Bimbingan:
Catatan :
Tanda Tangan
Mahasiswa: Promotor:
Topik Bimbingan:
Tanggal Bimbingan:
Catatan :
Tanda Tangan
Mahasiswa: Promotor:
Page 33
PASCASARJANA
Topik Bimbingan:
Tanggal Bimbingan:
Catatan :
Tanda Tangan
Mahasiswa: Promotor:
Topik Bimbingan:
Tanggal Bimbingan:
Catatan :
Tanda Tangan
Mahasiswa: Promotor:
Page 34
PASCASARJANA
Topik Bimbingan:
Tanggal Bimbingan:
Catatan :
Tanda Tangan
Mahasiswa: Promotor:
Topik Bimbingan:
Tanggal Bimbingan:
Catatan :
Tanda Tangan
Mahasiswa: Promotor:
Page 35
PASCASARJANA
Topik Bimbingan:
Tanggal Bimbingan:
Catatan :
Tanda Tangan
Mahasiswa: Promotor:
Topik Bimbingan:
Tanggal Bimbingan:
Catatan :
Tanda Tangan
Mahasiswa: Promotor:
Page 36
PASCASARJANA
Topik Bimbingan:
Tanggal Bimbingan:
Catatan :
Tanda Tangan
Mahasiswa: Promotor:
Topik Bimbingan:
Tanggal Bimbingan:
Catatan :
Tanda Tangan
Mahasiswa: Promotor:
Page 37
KEMENTERIAN AGAMA
UNIVERSITAS ISLAM NEGERI MAULANA MALIK IBRAHIM MALANG
PASCASARJANA Jalan Ir. Soekarno No. 34 Dadaprejo Faksimile (0341) 531130Kota Batu 65323, Telepon (0341) 531133
Website: http://pasca.uin-malang.ac.id, Email: [email protected]
No. Dokumen
UIN-QA/PM/14/05 FORMULIR PENDAFTARAN
UJIAN DISERTASI PENDAHULUAN (TERTUTUP)
Tanggal Terbit
5 Januari 2016
Revisi
0.00 -
Yang bertanda tangan di bawah ini:
1. Nama Lengkap : .............................................................................................................................................................
2. Tempat & Tgl. Lahir : .............................................................................................................................................................
3. N I M : .............................................................................................................................................................
4. Semester : .............................................................................................................................................................
5. Program Studi : .............................................................................................................................................................
6. Jumlah sks *) : .............................................................................................................................................................
7. Alamat rumah/telepon. : .............................................................................................................................................................
.............................................................................................................................................................
8. Judul Disertasi : .............................................................................................................................................................
.............................................................................................................................................................
9. Promotor : 1. ......................................................................................................................................................
2. ......................................................................................................................................................
3. ......................................................................................................................................................
10. Tanggal Penyerahan** : .............................................................................................................................................................
Mengajukan permohonan untuk didaftar sebagai peserta Ujian Disertasi Pendahuluan (Tertutup) pada Semester _____________ Tahun Akademik_______/_______untuk itu sebagai kelengkapan pendaftaran di bawah ini kami lampirkan hal-hal sebagai berikut:
11. Foto copy Transkrip Nilai
12. Pas foto ukuran 3 x 4 berwarna (3 lembar).
13. Foto copy surat keterangan lunas SPP dan herregistrasi
14. Foto copy Ijazah S-1, S-2 dan Transkrip (2 lembar)
15. Disertasi Pendahuluan dijilid soft cover 8 exemplar (warna merah maron)
16. Semua berkas dimasukkan ke dalam map plastik snelhechter warna merah
Batu,…………………………………………
Pendaftar,
.............................................................. (Nama Terang & Tanda Tangan)
Catatan: *) Jumlah keseluruan sks yang sudah ditempuh dan dinyatakan lulus. **) Di isi oleh petugas pendaftaran ***) Foto Copy Formulir Pendaftaran Ujian Proposal Disertasi ini
Page 38
KEMENTERIAN AGAMA
UNIVERSITAS ISLAM NEGERI MAULANA MALIK IBRAHIM MALANG
PASCASARJANA Jalan Ir. Soekarno No. 34 Dadaprejo Faksimile (0341) 531130Kota Batu 65323, Telepon (0341) 531133
Website: http://pasca.uin-malang.ac.id, Email: [email protected]
No. Dokumen
UIN-QA/PM/14/05 KARTU BIMBINGAN DISERTASI AKHIR
Tanggal Terbit
5 Januari 2016
Revisi
0.00 -
Nama : ......................................................................................................................................
NIM : ......................................................................................................................................
Program Studi : ......................................................................................................................................
Alamat : ......................................................................................................................................
......................................................................................................................................
......................................................................................................................................
No. Tlp dan HP : ......................................................................................................................................
Judul : ......................................................................................................................................
......................................................................................................................................
......................................................................................................................................
......................................................................................................................................
......................................................................................................................................
......................................................................................................................................
......................................................................................................................................
......................................................................................................................................
......................................................................................................................................
......................................................................................................................................
......................................................................................................................................
......................................................................................................................................
......................................................................................................................................
......................................................................................................................................
Tanggal Mulai Bimbingan : ......................................................................................................................................
Promotor : 1. ……………………………………………………………………………………………...
2. ……………………………………………………………………………………………...
3. ……………………………………………………………………………………………...
Page 39
PASCASARJANA
Topik Bimbingan:
Tanggal Bimbingan:
Catatan Bimbingan :
Tanda Tangan
Mahasiswa: Promotor:
Topik Bimbingan:
Tanggal Bimbingan:
Catatan Bimbingan :
Tanda Tangan
Mahasiswa: Promotor:
Page 40
PASCASARJANA
Topik Bimbingan:
Tanggal Bimbingan:
Catatan Bimbingan :
Tanda Tangan
Mahasiswa: Promotor:
Topik Bimbingan:
Tanggal Bimbingan:
Catatan Bimbingan :
Tanda Tangan
Mahasiswa: Promotor:
Page 41
PASCASARJANA
Topik Bimbingan:
Tanggal Bimbingan:
Catatan Bimbingan :
Tanda Tangan
Mahasiswa: Promotor:
Topik Bimbingan:
Tanggal Bimbingan:
Catatan Bimbingan :
Tanda Tangan
Mahasiswa: Promotor:
Page 42
PASCASARJANA
Topik Bimbingan:
Tanggal Bimbingan:
Catatan Bimbingan :
Tanda Tangan
Mahasiswa: Promotor:
Topik Bimbingan:
Tanggal Bimbingan:
Catatan Bimbingan :
Tanda Tangan
Mahasiswa: Promotor:
Page 43
PASCASARJANA
Topik Bimbingan:
Tanggal Bimbingan:
Catatan Bimbingan :
Tanda Tangan
Mahasiswa: Promotor:
Topik Bimbingan:
Tanggal Bimbingan:
Catatan Bimbingan :
Tanda Tangan
Mahasiswa: Promotor:
Page 44
PASCASARJANA
Topik Bimbingan:
Tanggal Bimbingan:
Catatan Bimbingan :
Tanda Tangan
Mahasiswa: Promotor:
Topik Bimbingan:
Tanggal Bimbingan:
Catatan Bimbingan :
Tanda Tangan
Mahasiswa: Promotor:
Page 45
PASCASARJANA
Topik Bimbingan:
Tanggal Bimbingan:
Catatan Bimbingan :
Tanda Tangan
Mahasiswa: Promotor:
Topik Bimbingan:
Tanggal Bimbingan:
Catatan Bimbingan :
Tanda Tangan
Mahasiswa: Promotor:
Page 46
PASCASARJANA
Topik Bimbingan:
Tanggal Bimbingan:
Catatan Bimbingan :
Tanda Tangan
Mahasiswa: Promotor:
Topik Bimbingan:
Tanggal Bimbingan:
Catatan Bimbingan :
Tanda Tangan
Mahasiswa: Promotor:
Page 47
PASCASARJANA
Topik Bimbingan:
Tanggal Bimbingan:
Catatan Bimbingan :
Tanda Tangan
Mahasiswa: Promotor:
Topik Bimbingan:
Tanggal Bimbingan:
Catatan Bimbingan :
Tanda Tangan
Mahasiswa: Promotor:
Page 48
PASCASARJANA
Topik Bimbingan:
Tanggal Bimbingan:
Catatan Bimbingan :
Tanda Tangan
Mahasiswa: Promotor:
Topik Bimbingan:
Tanggal Bimbingan:
Catatan Bimbingan :
Tanda Tangan
Mahasiswa: Promotor:
Page 49
PASCASARJANA
Topik Bimbingan:
Tanggal Bimbingan:
Catatan Bimbingan :
Tanda Tangan
Mahasiswa: Promotor:
Topik Bimbingan:
Tanggal Bimbingan:
Catatan Bimbingan :
Tanda Tangan
Mahasiswa: Promotor:
Page 50
PASCASARJANA
Topik Bimbingan:
Tanggal Bimbingan:
Catatan Bimbingan :
Tanda Tangan
Mahasiswa: Promotor:
Topik Bimbingan:
Tanggal Bimbingan:
Catatan Bimbingan :
Tanda Tangan
Mahasiswa: Promotor:
Page 51
KEMENTERIAN AGAMA
UNIVERSITAS ISLAM NEGERI MAULANA MALIK IBRAHIM MALANG
PASCASARJANA Jl. Ir. Soekarno No.34 Dadaprejo Kota Batu 65323, Telp. (0341) 531133 Fax. (0341) 531130
Website : http://pasca.uin-malang.ac.id, email : [email protected]
FORMULIR PENDAFTARAN UJIAN DISERTASI AKHIR (PROMOSI DOKTOR) PASCASARJANA
UNIVERSITAS ISLAM NEGERI MAULANA MALIK IBRAHIM MALANG
TAHUN AKADEMIK ………….--….……….
Yang bertanda tangan di bawah ini:
1. Nama : …………………………………………………………………………………………………………………….
2. NIM : …………………………………………………………………………………………………………………….
3. Tempat, tgl. lahir : …………………………………………………………………………………………………………………….
4. Semester : …………………………………………………………………………………………………………………….
5. Program Studi : …………………………………………………………………………………………………………………….
6. Alamat rumah/telepon.** : …………………………………………………………………………………………………………………….
…………………………………………………………………………………………………………………….
7. Judul Disertasi : …………………………………………………………………………………………………………………….
…………………………………………………………………………………………………………………….
8. Promotor : 1. ……………………………………………………………………………………………………………...
2. ……………………………………………………………………………………………………………...
3. ……………………………………………………………………………………………………………...
9. Tanggal Penyerahan Disertasi*
: …………………………………………………………………………………………………………………….
Dengan ini saya mendaftarkan diri sebagai peserta ujian Disertasi Akhir (Promosi Doktor) pada semester …………. Tahun Akademik
…….………. Pascasarjana Universitas Islam Negeri Maulana Malik Ibrahim Malang dengan melengkapi persyaratan serta berkas-berkas
yang diperlukan yaitu:
a. A Kuitansi pembayaran wisuda sesuai ketentuan (Asli)
b. Foto copy Transkrip Nilai
c. B Foto Copy Surat Keterangan Lunas SPP dan Herregistrasi
d. C Pas foto warna terbaru 3 X 4 sebanyak 8 lembar (sesuai dengan ketentuan BAK Pusat)
e. D Disertasi 12 exemplar, dijilid Hardcover Cover (warna merah maron)
f. E Foto copy Ijazah S-1, S-2 dan Transkrip (2 lembar)
g. F Berkas dimasukkan ke dalam Map Snelhechter /Map plastik warna Merah
Keterangan:
* Diisi oleh staf akademik
** Alamat rumah mohon ditulis lengkap untuk keperluan buku album wisuda dan data alumni.
Batu,......................................
Pendaftar,
-----------------------------------------------
Foto
3 X 4
Berwarna
Foto
3 X 4
Berwarna
Foto
3 X 4
Berwarna
Foto
3 X 4
Berwarna
Foto
3 X 4
Berwarna
A-1
Page 52
KEMENTERIAN AGAMA
UNIVERSITAS ISLAM NEGERI MAULANA MALIK IBRAHIM MALANG
PASCASARJANA Jl. Ir. Soekarno No. 34 Dadaprejo Kota Batu 65323, Telp. (0341) 531133 Fax. (0341) 531130
Website : http://pasca.uin-malang.ac.id, email : [email protected]
FORMULIR PENDAFTARAN UJIAN DISERTASI AKHIR (PROMOSI DOKTOR) PASCASARJANA
UNIVERSITAS ISLAM NEGERI MAULANA MALIK IBRAHIM MALANG
TAHUN AKADEMIK ………….--….……….
Yang bertanda tangan di bawah ini:
1. Nama : …………………………………………………………………………………………………………………….
2. NIM : …………………………………………………………………………………………………………………….
3. Tempat, tgl. lahir : …………………………………………………………………………………………………………………….
4. Semester : …………………………………………………………………………………………………………………….
5. Program Studi : …………………………………………………………………………………………………………………….
6. Alamat rumah/telepon.** : …………………………………………………………………………………………………………………….
…………………………………………………………………………………………………………………….
7. Judul Disertasi : …………………………………………………………………………………………………………………….
…………………………………………………………………………………………………………………….
8. Promotor : 1. ……………………………………………………………………………………………………………...
2. ……………………………………………………………………………………………………………...
3. ……………………………………………………………………………………………………………...
9. Tanggal Penyerahan Disertasi*
: …………………………………………………………………………………………………………………….
Dengan ini saya mendaftarkan diri sebagai peserta ujian Disertasi Akhir (Promosi Doktor) pada semester …………. Tahun Akademik
…….………. Pascasarjana Universitas Islam Negeri Maulana Malik Ibrahim Malang dengan melengkapi persyaratan serta berkas-berkas
yang diperlukan yaitu:
a. A Kuitansi pembayaran wisuda sesuai ketentuan (Asli)
b. B Foto Copy Surat Keterangan Lunas SPP dan Herregistrasi
c. C Pas foto warna terbaru 3 X 4 sebanyak 8 lembar (sesuai dengan ketentuan BAK Pusat)
d. D Disertasi 12 exemplar, dijilid Hardcover Cover (warna merah maron)
e. E Foto copy Ijazah S-1, S-2 dan Transkrip (2 lembar)
f. F Berkas dimasukkan ke dalam Map Snelhechter /Map plastik warna Merah
Keterangan:
* Diisi oleh staf akademik
** Alamat rumah mohon ditulis lengkap untuk keperluan buku album wisuda dan data alumni.
Batu,......................................
Pendaftar,
-----------------------------------------------
Foto
3 X 4
Berwarna
Foto
3 X 4
Berwarna
Foto
3 X 4
Berwarna
Foto
3 X 4
Berwarna
Foto
3 X 4
Berwarna
A-2