Formulir Pengajuan Jud

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Formulir Pengajuan Jud

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FORMULIR PENGAJUAN JUDUL

Nama : ………………………………………………………………………………………………………

NIM / NIRM : ………………………………………………………………………………………………………

Alamat : ………………………………………………………………………………………………………

: ………………………………………………………………………………………………………

No. HP. : ………………………………………………………………………………………………………

Judul yang diajukan :

…………………………………………………………………………………………………………………

Mojokerto, ………………………………………….
Yang Mengajukan,

……………………………………………………………………

PEMERIKSAAN KETUA JURUSAN Tgl,___________

⃝ Telah diteliti dan tidak mempunyai kesamaan dengan judul sebelumnya Paraf

⃝ ………………………………………………………………………………………………………………..

PEMERIKSAAN TIM Tgl,___________

⃝ Tidak menyulitkan dalam pelaksanaan penelitian, tidak
Paraf
menyinggung sara, tidak melanggar norma-norma yang berlaku

⃝ ………………………………………………………………………………………………………………..

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