INSTITUT TEKNOLOGI NASIONAL YOGYAKARTA (ITNY) DEPARTEMEN TEKNIK GEOLOGI (S1) DEPARTEMEN TEKNIK SIPIL (S1) DEPARTEMEN TEKNIK MESIN (S1) DEPARTEMEN TEKNIK ELEKTRO (S1) DEPARTEMEN TEKNIK PERTAMBANGAN (S1) DEPARTEMEN PERENCANAAN WILAYAH DAN KOTA (S1) Jl. Babarsari, Caturtunggal, Depok, Sleman 55281 Telp.(0274) 485390, 486986, 487540 Fax. (0274) 487249 BLANGKO PENGAJUAN YUDISIUM Yang bertanda tangan di bawah ini : Nama : ………………………………………………………………………………………………………………………………. No. Mhs : ………………………………………………………………………………………………………………………………. Angkatan Tahun : ………………………………………………………………………………………………………………………………. Tempat/tgl lahir : ………………………………………………………………………………………………………………………………. Judul Skripsi : ………………………………………………………………………………………………………………………………. ………………………………………………………………………………………………………………………………. ………………………………………………………………………………………………………………………………. Pembimbing I : ………………………………………………………………………………………………………………………………. Pembimbing 2 : ………………………………………………………………………………………………………………………………. Judul Seminar : ………………………………………………………………………………………………………………………………. Pembimbing Seminar : ………………………………………………………………………………………………………………………………. Tanggal Pendadaran : ………………………………………………………………………………………………………………………………. IPK : ....................................................... ..................................................................... Predikat Kelulusan : ………………………………………………………………………………………………………………………………. Lama Studi Efektif : ………………………………………………………………………………………………………………………………. No. Telp / HP : ………………………………………………………………………………………………………………………………. Email : ………………………………………………………………………………………………………………………………. Alamat asal : ………………………………………………………………………………………………………………………………. ………………………………………………………………………………………………………………………………. Yogyakarta, ……………………………………… ( Lampiran Persyaratan :
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INSTITUT TEKNOLOGI NASIONAL YOGYAKARTA (ITNY)
DEPARTEMEN TEKNIK GEOLOGI (S1)DEPARTEMEN TEKNIK SIPIL (S1)DEPARTEMEN TEKNIK MESIN (S1)
DEPARTEMEN TEKNIK ELEKTRO (S1)DEPARTEMEN TEKNIK PERTAMBANGAN (S1)DEPARTEMEN PERENCANAAN WILAYAH DAN KOTA (S1)
Jl. Babarsari, Caturtunggal, Depok, Sleman 55281 Telp.(0274) 485390, 486986, 487540 Fax. (0274) 487249
BLANGKO PENGAJUAN YUDISIUM
Yang bertanda tangan di bawah ini :
Nama : ……………………………………………………………………………………………………………………………….
No. Mhs : ……………………………………………………………………………………………………………………………….
Angkatan Tahun : ……………………………………………………………………………………………………………………………….
Tempat/tgl lahir : ……………………………………………………………………………………………………………………………….
Judul Skripsi : ……………………………………………………………………………………………………………………………….
……………………………………………………………………………………………………………………………….
……………………………………………………………………………………………………………………………….
Pembimbing I : ……………………………………………………………………………………………………………………………….
Pembimbing 2 : ……………………………………………………………………………………………………………………………….
Judul Seminar : ……………………………………………………………………………………………………………………………….
Pembimbing Seminar : ……………………………………………………………………………………………………………………………….
Tanggal Pendadaran : ……………………………………………………………………………………………………………………………….
IPK : ............................................................................................................................
Predikat Kelulusan : ……………………………………………………………………………………………………………………………….
Lama Studi Efektif : ……………………………………………………………………………………………………………………………….
No. Telp / HP : ……………………………………………………………………………………………………………………………….
Email : ……………………………………………………………………………………………………………………………….
Alamat asal : ……………………………………………………………………………………………………………………………….
……………………………………………………………………………………………………………………………….
Yogyakarta, ………………………………………
( )
Lampiran Persyaratan :
1. Foto 3 x 4 berwarna 2. 1 buah CD dengan format pdf 3. Bukti Penyerahan Skripsi dari Perpustakaan4. 1 eks Naskah Publikasi5. Surat Keterangan Bebas dari : Perpustakaan, Seluruh Laboratorium6. Transkip Nilai Asli yang telah disahkan BAA.7. 1 lembar copy pembayaran Yudisium dan Status
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