Page 1
JUDUL PROPOSAL SKRIPSI/TESIS/DISERTASI (14pt)(SUBJUDUL SKRIPSI/TESIS/DISERTASI)* (12pt)
PROPOSAL SKRIPSI/TESIS/DISERTASI
olehWahyu Jatmiko (Nama Mahasiswa)
09/123456/PTK/123 (Nomor Mahasiswa)
PROGRAM STUDI SARJANA/MAGISTER/DOKTOR TEKNIK GEOLOGIDEPARTEMEN TEKNIK GEOLOGI
FAKULTAS TEKNIKUNIVERSITAS GADJAH MADA
YOGYAKARTAJanuari 2018
*jika ada
COVER LUAR PROPOSAL
Page 2
UNDERGRADUATE THESIS/MASTER THESIS/DISSERTATION PROPOSAL TITLE (14pt)
(UNDERGRADUATE THESIS/MASTER THESIS/DISSERTATION SUBTITLE)* (12pt)
PROPOSAL UNDERGRADUATE/MASTER THESIS/DISSERTATION
by Emil Karmila (Name of Student)
10/123456/PMU/234 (Academic Number)
BACHELOR IN GEOLOGICAL ENGINEERING PROGRAM/MASTER IN GEOLOGICAL ENGINEERING PROGRAM/DOCTOR IN GEOLOGICAL
ENGINEERING PROGRAMDEPARTMENT OF GEOLOGICAL ENGINEERING
FACULTY OF ENGINEERINGUNIVERSITAS GADJAH MADA
YOGYAKARTAJanuary, 2018
*if any
PROPOSAL OUTER COVER
Page 3
JUDUL SKRIPSI/TESIS/DISERTASI (14pt)(SUBJUDUL SKRIPSI/TESIS/DISERTASI) (12pt)
SKRIPSI/TESIS/DISERTASI
olehWahyu Jatmiko (Nama Mahasiswa)
09/123456/PTK/123 (Nomor Mahasiswa)
PROGRAM STUDI SARJANA/MAGISTER/DOKTOR TEKNIK GEOLOGIDEPARTEMEN TEKNIK GEOLOGI
FAKULTAS TEKNIKUNIVERSITAS GADJAH MADA
YOGYAKARTA2018
COVER LUAR SKRIPSI/TESIS/DISERTASI
Page 4
UNDERGRADUATE THESIS/MASTER THESIS/DISSERTATION TITLE (14pt)
(UNDERGRADUATE THESIS/MASTER THESIS/DISSERTATION SUBTITLE) (12pt)
UNDERGRADUATE THESIS/MASTER THESIS/DISSERTATION
by Emil Karmila (Name of Student)
10/123456/PMU/234 (Academic Number)
BACHELOR IN GEOLOGICAL ENGINEERING PROGRAM/MASTER IN GEOLOGICAL ENGINEERING PROGRAM/DOCTOR IN GEOLOGICAL
ENGINEERING PROGRAMDEPARTMENT OF GEOLOGICAL ENGINEERING
FACULTY OF ENGINEERINGUNIVERSITAS GADJAH MADA
YOGYAKARTA2018
UNDERGRADUATE THESIS/MASTER THESIS/DISSERTATION OUTER COVER
Page 5
JUDUL NASKAH PUBLIKASI/RINGKASAN
NASKAH PUBLIKASI/RINGKASAN
olehWahyu Jatmiko (Nama Mahasiswa)
09/123456/PTK/123 (Nomor Mahasiswa)
PROGRAM STUDI MAGISTER/DOKTOR TEKNIK GEOLOGIDEPARTEMEN TEKNIK GEOLOGI
FAKULTAS TEKNIKUNIVERSITAS GADJAH MADA
YOGYAKARTA2018
COVER LUAR NASKAH PUBLIKASI/RINGKASAN
Page 6
PUBLICATION/SUMMARY TITLE
PUBLICATION/SUMMARY
by Emil Karmila (Name of Student)
10/123456/PMU/234 (Academic Number)
MASTER IN GEOLOGICAL ENGINEERING PROGRAM/DOCTOR IN GEOLOGICAL ENGINEERING PROGRAM
DEPARTMENT OF GEOLOGICAL ENGINEERING FACULTY OF ENGINEERING
UNIVERSITAS GADJAH MADAYOGYAKARTA
2018
PUBLICATION/SUMMARY MANUSCRIPT OUTER COVER
Page 7
JUDUL PROPOSAL SKRIPSI/TESIS/DISERTASI (14pt)(SUBJUDUL SKRIPSI/TESIS/DISERTASI) (12pt)
Proposal Skripsi/Tesis/DisertasiProgram Studi Sarjana/Magister/Doktor Teknik Geologi
diajukan olehWahyu Jatmiko (Nama Mahasiswa)
09/123456/PTK/123 (Nomor Mahasiswa)
kepadaPROGRAM STUDI SARJANA/MAGISTER/DOKTOR TEKNIK GEOLOGI
DEPARTEMEN TEKNIK GEOLOGIFAKULTAS TEKNIK
UNIVERSITAS GADJAH MADAYOGYAKARTA
Januari, 2018
COVER DALAM PROPOSAL
Page 8
UNDERGRADUATE THESIS/MASTER THESIS/DISSERTATION PROPOSAL TITLE (14pt)
Undergraduate Thesis/Master Thesis/Dissertation ProposalBachelor in Geological Engineering Program/Master in Geological Engineering
Program/Doctor in Geological Engineering Program
submitted by Emil Karmila (Name of Student)
10/123456/PMU/234 (Academic Number)
toBACHELOR IN GEOLOGICAL ENGINEERING PROGRAM/MASTER IN GEOLOGICAL ENGINEERING PROGRAM/DOCTOR IN GEOLOGICAL
ENGINEERING PROGRAMDEPARTMENT OF GEOLOGICAL ENGINEERING
FACULTY OF ENGINEERINGUNIVERSITAS GADJAH MADA
YOGYAKARTAJanuary, 2018
PROPOSAL INNER COVER
Page 9
JUDUL SKRIPSI/TESIS/DISERTASI (14pt) (SUBJUDUL SKRIPSI/TESIS/DISERTASI) (12pt)
Skripsi/Tesis/Disertasiuntuk memenuhi sebagian persyaratan
mencapai derajat Sarjana/Master/DoktorProgram Studi Sarjana/Magister/Doktor Teknik Geologi
diajukan olehTarman Azzam (nama mahasiswa)
08/278256/PTK/5811 (nomor mahasiswa)
kepadaPROGRAM STUDI SARJANA/MAGISTER/DOKTOR TEKNIK GEOLOGI
DEPARTEMEN TEKNIK GEOLOGIFAKULTAS TEKNIK
UNIVERSITAS GADJAH MADAYOGYAKARTA
2018
COVER DALAM SKRIPSI/TESIS/DISERTASI
Page 10
UNDERGRADUATE THESIS/MASTER THESIS/DISSERTATION TITLE
Undergraduate Thesis/Master Thesis/Dissertationpresented as partial fulfilment for the requirement
to obtain the Bachelor Degree/Master Degree/Doctoral Degree in Bachelor in Geological Engineering Program/Master in Geological Engineering
Program/Doctor in Geological Engineering Program
submitted by Tarman Azzam (name of student)
08/278256/PMU/5811 (academic number)
toBACHELOR IN GEOLOGICAL ENGINEERING PROGRAM/MASTER IN GEOLOGICAL ENGINEERING PROGRAM/DOCTOR IN GEOLOGICAL
ENGINEERING PROGRAMDEPARTMENT OF GEOLOGICAL ENGINEERING
FACULTY OF ENGINEERINGUNIVERSITAS GADJAH MADA
YOGYAKARTA2018
UNDERGRADUATE THESIS/MASTER THESIS/DISSERTATION INNER COVER
Page 11
JUDUL PROPOSAL DISERTASI/DISERTASI (14pt) (SUBJUDUL PROPOSAL DISERTASI/DISERTASI) (12pt)
Proposal Disertasi/Disertasiuntuk memperoleh derajat Doktor dalam Ilmu Geologi
Program Studi Doktor Teknik GeologiFakultas Teknik
Universitas Gadjah Mada
diajukan olehTarman Azzam (nama mahasiswa)
08/278256/PTK/5811 (nomor mahasiswa)
lahirdi ……………….
COVER DALAM PROPOSAL DISERTASI/DISERTASI #1Cover ini dipergunakan sebelum ujian proposal/ujian
tertutup
Page 12
DISSERTATION PROPOSAL/DISSERTATION TITLE (14pt)(DISSERTATION PROPOSAL/DISSERTATION SUBTITLE)* (12pt)
Dissertation Proposal/Dissertationto obtain the Doctoral Degree in Geological Engineering
Faculty of EngineeringUniversitas Gadjah Mada
submitted byTarman Azzam (nama mahasiswa)
08/278256/PTK/5811 (nomor mahasiswa)
bornin ……………….
DISSERTATION PROPOSAL/DISSERTATION INNER COVER #1This cover is used before proposal examination/closed
examination
Page 13
JUDUL PROPOSAL DISERTASI/DISERTASI (14pt) (SUBJUDUL PROPOSAL DISERTASI/DISERTASI) (12pt)
Proposal Disertasi/Disertasiuntuk memperoleh derajat Doktor
Program Studi Doktor Teknik Geologi
Dipertahankan di hadapan Dewan Penguji Program Studi Doktor Teknik Geologi
Fakultas Teknik Universitas Gadjah Mada
Pada Tanggal ……..
diajukan olehTarman Azzam (nama mahasiswa)
08/278256/PTK/5811 (nomor mahasiswa)
lahirdi ……………….
COVER DALAM PROPOSAL DISERTASI/DISERTASI #2Cover ini dipergunakan setelah ujian proposal/ujian
tertutup
Page 14
DISSERTATION PROPOSAL/DISSERTATION TITLE (14pt)(DISSERTATION PROPOSAL/DISSERTATION SUBTITLE)* (12pt)
Dissertation Proposal/Dissertationto obtain the Doctoral Degree in Geological Engineering
Faculty of EngineeringUniversitas Gadjah Mada
was defended in front of the Board of Examinersin Doctor in Geological Engineering Program
Faculty of EngineeringUniversitas Gadjah Mada
on the date ……. (date of exam)
submitted byTarman Azzam (nama mahasiswa)
08/278256/PTK/5811 (nomor mahasiswa)
bornin ……………….
DISSERTATION PROPOSAL/DISSERTATION INNER COVER #2This cover is used after proposal examination/closed
examination
Page 15
DISSERTATION PROPOSAL/DISSERTATION TITLE (14pt)(DISSERTATION PROPOSAL/DISSERTATION SUBTITLE)* (12pt)
Dissertation Proposal/Dissertationto obtain the Doctoral Degree in Geological Engineering
Faculty of EngineeringUniversitas Gadjah Mada
was defended in front of the Board of Examinersin Doctor in Geological Engineering Program
Faculty of EngineeringUniversitas Gadjah Mada
on the date ……. (date of exam)
submitted byTarman Azzam (name of Student)
08/278256/PTK/5811 (academic number)
bornin ……………….
DISSERTATION PROPOSAL/DISSERTATION INNER COVER #2This cover is used after proposal examination/closed
examination
Page 16
PROPOSAL SKRIPSI/TESIS
JUDUL PROPOSAL SKRIPSI/TESIS(SUBJUDUL PROPOSAL SKRIPSI/TESIS)
diajukan olehWahyu Jatmiko (Nama mahasiswa)
09/123456/PMU/123 (Nomor Mahasiswa)
disetujui oleh
Calon Pembimbing Utama, Calon Pembimbing Pendamping,
Nama Dosen Nama DosenNIP Dosen NIP Dosen
Lembar Pengesahan ini dipakai sebelum/untuk mengajukan ujian proposal
Page 17
PROPOSAL SKRIPSI/TESIS
JUDUL PROPOSAL SKRIPSI/TESIS(SUBJUDUL PROPOSAL SKRIPSI/TESIS)
diajukan olehWahyu Jatmiko (Nama mahasiswa)
09/123456/PMU/123 (Nomor Mahasiswa)
disetujui oleh:
Calon Pembimbing Utama,
Nama DosenNIP Dosen
Lembar Pengesahan ini dipakai sebelum/untuk mengajukan ujian proposal
Page 18
UNDERGRADUATE THESIS/MASTER THESIS PROPOSAL
UNDERGRADUATE THESIS/ MASTER THESIS PROPOSAL TITLE(UNDERGRADUATE THESIS/MASTER THESIS PROPOSAL SUBTITLE)
Submitted byWahyu Jatmiko (Nama mahasiswa)
09/123456/PMU/123 (Nomor Mahasiswa)
Approved by
Candidate of Supervisor, Candidate of Co-Supervisor,
Name NameNIP NIP
This attestation form is used before/for applying proposal examination
Page 19
UNDERGRADUATE THESIS/MASTER THESIS PROPOSAL
UNDERGRADUATE THESIS/MASTER THESIS PROPOSAL TITLE(UNDERGRADUATE THESIS/MASTER THESIS PROPOSAL SUBTITLE)
Submitted byWahyu Jatmiko (Nama mahasiswa)
09/123456/PMU/123 (Nomor Mahasiswa)
Approved by
Candidate of Supervisor,
Name NIP
This attestation form is used before/for applying proposal examination
Page 20
PROPOSAL DISERTASI/DISERTASI
JUDUL PROPOSAL DISERTASI/DISERTASI
diajukan olehWahyu Jatmiko (Nama mahasiswa)
09/123456/PMU/123 (Nomor Mahasiswa)
yang diajukan untuk ujian proposal/ujian tertutup
disetujui oleh:
Nama tanggal ………………….Promotor
Nama tanggal ………………….Ko-Promotor I
NamaKo-Promotor II tanggal ………………….
Halaman persetujuan ini dipergunakan sebelum ujian proposal/ujian tertutup
Page 21
DISSERTATION PROPOSAL/DISSERTATION
DISSERTATION PROPOSAL/DISSERTATION TITLE
submitted byWahyu Jatmiko (name of student)
09/123456/PMU/123 (academic number)
was submitted for proposal examination/closed examination
approved by:
Name date ………………….Supervisor
Nama date ………………….Co- Supervisor I
NamaCo- Supervisor II date ………………….
This attestation form is used before proposal examination/closed examination
Page 22
PROPOSAL SKRIPSI/TESIS
JUDUL PROPOSAL SKRIPSI/TESIS(SUBJUDUL PROPOSAL SKRIPSI/TESIS)
yang dipersiapkan dan disusun olehWahyu Jatmiko (Nama mahasiswa)
09/123456/PMU/123 (Nomor Mahasiswa)telah dipresentasikan di depan Dewan Penguji
pada tanggal ....dan dinyatakan diterima dan diperbaiki sesuai hasil ujian proposal
Susunan Tim Penguji
Calon Pembimbing Utama, Ketua Penguji,
Nama Dosen Nama DosenNIP Dosen NIP Dosen
Calon Pembimbing Pendamping, Anggota Penguji,
Nama Dosen Nama DosenNIP Dosen NIP Dosen
Yogyakarta, …………… 20 …Ketua Program Studi Sarjana/Magister Teknik Geologi,
Nama ……………NIP ……………
Lembar pengesahan ini dipakai setelah ujian proposal/revisi akhir
Page 23
PROPOSAL SKRIPSI/TESIS
JUDUL PROPOSAL SKRIPSI/TESIS(SUBJUDUL PROPOSAL SKRIPSI/TESIS)
yang dipersiapkan dan disusun olehWahyu Jatmiko (Nama mahasiswa)
09/123456/PMU/123 (Nomor Mahasiswa)telah dipresentasikan di depan Dewan Penguji
pada tanggal ....dan dinyatakan diterima dan diperbaiki sesuai hasil ujian proposal
Susunan Tim Penguji
Calon Pembimbing, Ketua Penguji,
Nama Dosen Nama DosenNIP Dosen NIP Dosen
Anggota Penguji,
Nama DosenNIP Dosen
Yogyakarta, …………… 20 …Ketua Program Studi Sarjana/Magister Teknik Geologi,
Nama ……………NIP ……………
Lembar pengesahan ini dipakai setelah ujian proposal/revisi akhir
Page 24
UNDERGRADUATE THESIS/MASTER THESIS PROPOSAL
UNDERGRADUATE THESIS/MASTER THESIS PROPOSAL TITLE
prepared by Emil Karmila (name of student)
10/123456/PMU/234 (academic number)presented to the Board of Examiners
on ………….. (date of exam) and accepted and revised according to the proposal exam
Board of Examiners
Supervisor, Chairman,
Name Name NIP NIP
Co-Supervisor, Examiner,
Name Name NIP NIP
Yogyakarta, ………………… 20 ……..Program Manager of Bachelor in Geological Engineering/Master in Geological Engineering,
Name ……………NIP ……………
This attestation form is used after proposal examination/final revision
Page 25
UNDERGRADUATE THESIS/MASTER THESIS PROPOSAL
UNDERGRADUATE THESIS/MASTER THESIS PROPOSAL TITLE
prepared by Emil Karmila (name of student)
10/123456/PMU/234 (academic number)presented to the Board of Examiners
on ………….. (date of exam) and accepted and revised according to the proposal exam
Board of Examiners
Advisor, Chairman,
Name Name NIP NIP
Examiner,
Name NIP
Yogyakarta, ………………… 20 ……..Program Manager of Bachelor in Geological Engineering/Master in Geological Engineering,
Name ……………NIP ……………
This attestation form is used after proposal examination/final revision
Page 26
SKRIPSI/TESIS
JUDUL SKRIPSI/TESIS(SUBJUDUL SKRIPSI/TESIS)
diajukan olehWahyu Jatmiko (Nama mahasiswa)
09/123456/PMU/123 (Nomor Mahasiswa)
disetujui oleh
Pembimbing Utama, Pembimbing Pendamping,
Nama Dosen Nama DosenNIP Dosen NIP Dosen
Yogyakarta, …………… 20 …Ketua Program Studi Sarjana/Magister Teknik Geologi,
Nama ……………NIP ……………
Lembar pengesahan ini dipakai setelah ujian kolokium/untuk mengajukan ujian skripsi/tesis
Page 27
SKRIPSI/TESIS
JUDUL SKRIPSI/TESIS(SUBJUDUL SKRIPSI/TESIS)
diajukan olehWahyu Jatmiko (Nama mahasiswa)
09/123456/PMU/123 (Nomor Mahasiswa)
disetujui oleh
Pembimbing Utama,
Nama DosenNIP Dosen
Yogyakarta, …………… 20 …Ketua Program Studi Sarjana/Magister Teknik Geologi,
Nama ……………NIP ……………
Lembar pengesahan ini dipakai setelah ujian kolokium/untuk mengajukan ujian skripsi/tesis
Page 28
UNDERGRADUATE THESIS/MASTER THESIS
UNDERGRADUATE THESIS/ MASTER THESIS TITLE(UNDERGRADUATE THESIS/MASTER THESIS SUBTITLE)
Submitted byWahyu Jatmiko (Nama mahasiswa)
09/123456/PMU/123 (Nomor Mahasiswa)
Approved by
Supervisor, Co-Supervisor,
Name NameNIP NIP
Yogyakarta, ………………… 20 ……..Program Manager of Bachelor in Geological Engineering/Master in Geological Engineering,
Name ……………NIP ……………
This attestation form is used after colloquium examination/for applying undergraduate
thesis/thesis examination
Page 29
UNDERGRADUATE THESIS/MASTER THESIS
UNDERGRADUATE THESIS/MASTER THESIS TITLE(UNDERGRADUATE THESIS/MASTER THESIS SUBTITLE)
Submitted byWahyu Jatmiko (Nama mahasiswa)
09/123456/PMU/123 (Nomor Mahasiswa)
Approved by
Supervisor,
Name NIP
Yogyakarta, ………………… 20 ……..Program Manager of Bachelor in Geological Engineering/Master in Geological Engineering,
Name ……………NIP ……………
This attestation form is used after colloquium examination/for applying undergraduate
thesis/thesis examination
Page 30
PROPOSAL DISERTASI/DISERTASI
JUDUL PROPOSAL DISERTASI/DISERTASI
diajukan olehWahyu Jatmiko (Nama mahasiswa)
09/123456/PMU/123 (Nomor Mahasiswa)
yang telah diperbaiki sesuai saran dari Tim Penguji Ujian Proposal/Tim Penguji Ujian Tertutup
disetujui oleh:
Nama tanggal ………………….Promotor
Nama tanggal ………………….Ko-Promotor I
NamaKo-Promotor II tanggal ………………….
Nama tanggal ………………….Penguji
NamaPenguji tanggal ………………….
NamaPenguji tanggal ………………….
Halaman persetujuan ini dipergunakan setelah ujian proposal/ujian tertutup
Page 31
DISSERTATION PROPOSAL/DISSERTATION
DISSERTATION PROPOSAL/DISSERTATION TITLE
submitted byWahyu Jatmiko (name of student)
09/123456/PMU/123 (academic number)
was revised according to The Board of Examiners suggestion of Proposal Examination/Closed Examination
approved by:
Name date ………………….Promoter
Name date ………………….Co-Promoter I
NameCo-Promoter II date ………………….
Name date ………………….Examiner
NameExaminer date ………………….
NameExaminer date ………………….
This attestation form is used after proposal examination/closed examination
Page 32
SKRIPSI/TESIS
JUDUL SKRIPSI/TESIS
yang dipersiapkan dan disusun olehWahyu Jatmiko (Nama mahasiswa)
09/123456/PTK/123 (Nomor Mahasiswa)telah dipertahankan di depan Dewan Penguji
pada tanggal ....dan dinyatakan lulus
Susunan Tim Penguji
Pembimbing Utama, Ketua Penguji,
Nama Dosen Nama DosenNIP Dosen NIP Dosen
Pembimbing Pendamping, Anggota Penguji,
Nama Dosen Nama DosenNIP Dosen NIP Dosen
Skripsi/Tesis ini telah diterima sebagai salah satu syaratuntuk mendapatkan gelar Sarjana/Master Teknik Program Studi Sarjana/Magister Teknik Geologi
Fakultas Teknik, Universitas Gadjah MadaYogyakarta, …………… 20 …
Ketua Program Studi Sarjana/Magister Teknik Geologi,
Nama ……………NIP ……………
Mengetahui,Ketua Departemen Teknik Geologi,
Nama ……………
Lembar pengesahan ini dipakai setelah ujian pendadaran skripsi/tesis (setelah
revisi final)
Page 33
NIP ……………
SKRIPSI/TESIS
JUDUL SKRIPSI/TESIS
yang dipersiapkan dan disusun olehWahyu Jatmiko (Nama mahasiswa)
09/123456/PTK/123 (Nomor Mahasiswa)telah dipertahankan di depan Dewan Penguji
pada tanggal ....dan dinyatakan lulus
Susunan Tim Penguji
Pembimbing, Ketua Penguji,
Nama Dosen Nama DosenNIP Dosen NIP Dosen
Anggota Penguji,
Nama DosenNIP Dosen
Skripsi/Tesis ini telah diterima sebagai salah satu syaratuntuk mendapatkan gelar Sarjana/Master Teknik Program Studi Sarjana/Magister Teknik Geologi
Fakultas Teknik, Universitas Gadjah Mada
Yogyakarta, …………… 20 …Ketua Program Studi Sarjana/Magister Teknik Geologi,
Nama ……………NIP ……………
Mengetahui,Ketua Departemen Teknik Geologi,
Lembar pengesahan ini dipakai setelah ujian pendadaran skripsi/tesis (setelah
revisi final)
Page 34
Nama ……………NIP ……………
UNDERGRADUATE THESIS/MASTER THESIS
UNDERGRADUATE THESIS/MASTER THESIS TITLE
Prepared by Tarman Azzam (name of student)
08/278256/PTK/5811 (academic number)was defended in front of the Board of Examiners
on the date ……. (date of exam)and certified
Board of Examiners
Supervisor, Chairman,
Name Name NIP NIP
Co-Supervisor, Examiner,
Name Name NIP NIP
This script/thesis was declared acceptableto obtain The Bachelor Degree/Master Degree
in Geological Engineering Faculty of Engineering, Universitas Gadjah Mada
Yogyakarta, …………… 20 …Program Manager,
Name ……………NIP ……………
AcknowledgedHead of Geological Engineering Departement,
This attestation form is used after final examination (after final revision)
Page 35
Name ……………NIP ……………
UNDERGRADUATE THESIS/MASTER THESIS
UNDERGRADUATE THESIS/MASTER THESIS TITLE
Prepared by Tarman Azzam (name of student)
08/278256/PTK/5811 (academic number)was defended in front of the Board of Examiners
on the date ……. (date of exam)and certified
Board of Examiners
Supervisor, Chairman,
Name Name NIP NIP
Examiner,
Name NIP
This script/thesis/dissertation was declared acceptableto obtain The Bachelor Degree/Master Degree
in Geological Engineering Faculty of Engineering, Universitas Gadjah Mada
Yogyakarta, …………… 20 …Program Manager,
Name ……………NIP ……………
AcknowledgedHead of Geological Engineering Departement,
Name ……………NIP ……………
This attestation form is used after final examination (after final revision)
Page 36
DISERTASI
JUDUL DISERTASI
diajukan olehWahyu Jatmiko (Nama mahasiswa)
09/123456/PMU/123 (Nomor Mahasiswa)
yang telah diperbaiki sesuai saran dari Tim Penguji Ujian Tertutup
disetujui oleh:
Nama tanggal ………………….Ketua Tim Penguji
Nama tanggal ………………….Promotor
Nama tanggal ………………….Ko-Promotor I
NamaKo-Promotor II tanggal ………………….
Nama tanggal ………………….Penguji
NamaPenguji tanggal ………………….
Halaman persetujuan ini dipergunakan sebagai lampiran/kelengkapan syarat yudisium/ujian
terbuka/wisuda (terpisah dari disertasi)
Page 37
NamaPenguji tanggal ………………….
DISSERTATION
DISSERTATION TITLE
submitted byWahyu Jatmiko (name of student)
09/123456/PMU/123 (academic number)
was revised according to The Board of Examiners suggestion of Closed Examination
approved by:
Name date ………………….Chairman
Name date ………………….Supervisor
Name date ………………….Co-Supervisor I
NameCo-Suoervisor II date ………………….
Name date ………………….Examiner
NameExaminer date ………………….
This attestation form is used as attachment file/part of list of judisium requirement/open examination/graduation
ceremony (separated from dissertation)
Page 38
NameExaminer date ………………….
NASKAH PUBLIKASI/RINGKASAN
JUDUL PUBLIKASI/RINGKASAN
olehWahyu Jatmiko (Nama mahasiswa)
09/123456/PMU/123 (Nomor Mahasiswa)
disetujui oleh
Pembimbing Utama, Pembimbing Pendamping,
Nama Dosen Nama DosenNIP Dosen NIP Dosen
Mengetahui,Ketua Program Studi Magister Teknik Geologi,
Nama ……………NIP ……………
Lembar pengesahan Naskah Publikasi/Ringkasan
Page 39
PUBLICATION/SUMMARY MANUSCRIPT
PUBLICATION/SUMMARY TITLE
byWahyu Jatmiko (Nama mahasiswa)
09/123456/PMU/123 (Nomor Mahasiswa)
Approved by
Supervisor, Co-Supervisor,
Name NameNIP NIP
Acknowledged,Program Manager of Master in Geological Engineering,
Name ……………NIP ……………
publication/summary attestation form