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KEMENTERIAN RISET, TEKNOLOGI DAN PENDIDIKAN TINGGI

UNIVERSITAS BRAWIJAYA
FAKULTAS KEDOKTERAN HEWAN
PROGRAM STUDI : S-1 PENDIDIKAN DOKTER HEWAN
Jl. M.T. Haryono 169 Malang 65145 Telp/Fax. 0341-573642 Email : pskh_ub@ub..ac.id

Pengajuan Rencana SKRIPSI (PKH4801)


NIM : .................................. Nama MHS : ..................................................

No HP :............................................... (yang bisa dihubungi)

IP Kumulatif : ................................ SKS Kumulatif : ............................................

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

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Mengikuti Payung Penelitian Dosen : Ya / Tidak

Nama Dosen Peneliti : .....................................................................................................

Calon Pembimbing

Pembimbing 1 : .....................................................................

NIP : ......................................................................

Pembimbing 2 : .....................................................................

NIP : ......................................................................

Di isi oleh Ketua Program Studi

Malang, .................................... Yang Mengajukan,


Wakil Dekan 1

drh.Dyah Ayu Oktavianie A.P.,M.Biotech ............................................................


NIP. 19841026 200812 2 004 NIM....................................................