47
JUDUL PROPOSAL SKRIPSI/TESIS/DISERTASI (14pt) (SUBJUDUL SKRIPSI/TESIS/DISERTASI)* (12pt) PROPOSAL SKRIPSI/TESIS/DISERTASI oleh Wahyu Jatmiko (Nama Mahasiswa) 09/123456/PTK/123 (Nomor Mahasiswa) PROGRAM STUDI SARJANA/MAGISTER/DOKTOR TEKNIK GEOLOGI DEPARTEMEN TEKNIK GEOLOGI FAKULTAS TEKNIK UNIVERSITAS GADJAH MADA YOGYAKARTA COVER LUAR PROPOSAL

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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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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)

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)

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)

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)

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)

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)

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

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