10.06.2016 Views

Panduan_Pelaksanaan_Penelitian_dan_PPM_Edisi_X_2016

Create successful ePaper yourself

Turn your PDF publications into a flip-book with our unique Google optimized e-Paper software.

Lampiran 24.2 Format Halaman Pengesahan Program Iptek bagi Kreativitas <strong>dan</strong><br />

Inovasi Kampus<br />

HALAMAN PENGESAHAN<br />

PROGRAM IPTEK BAGI KREATIVITAS DAN INOVASI KAMPUS<br />

1. Judul IbKIK : ....................................................................................<br />

2. Unit Lembaga Pengusul : ....................................................................................<br />

3. Ketua Tim Pengusul<br />

a. Nama lengkap : ....................................................................................<br />

b. NIDN : ....................................................................................<br />

c. Jabatan/Golongan : ....................................................................................<br />

d. Perguruan tinggi : ....................................................................................<br />

4. Anggota Tim Pengusul Kegiatan : ....... orang (dosen)<br />

5. Jangka Waktu <strong>Pelaksanaan</strong> :…… tahun<br />

6. Rencana Belanja Total : Rp .......................................<br />

a. DRPM : Rp .......................................<br />

b. Perguruan Tinggi : Rp .......................................<br />

c. Kredit Usaha : Rp .......................................<br />

d. Sumber lain (apabila ada) : Rp .......................................<br />

7. Belanja Tahun : ke …… (I/II/III*), Rp .......................................<br />

a. DRPM : Rp .......................................<br />

b. Perguruan Tiggi : Rp .......................................<br />

Mengetahui,<br />

Dekan<br />

Cap <strong>dan</strong> tanda tangan<br />

(Nama Lengkap)<br />

NIP/NIK<br />

Mengetahui<br />

Ketua LPM/L<strong>PPM</strong> *<br />

Cap <strong>dan</strong> tanda tangan<br />

(Nama Lengkap)<br />

NIP/NIK<br />

Kota, tanggal-bulan-tahun<br />

Ketua Tim Pengusul<br />

Tanda tangan<br />

(Nama Lengkap)<br />

NIP/NIK<br />

* Disesuaikan dengan nama lembaga atau unit pengabdian kepada masyarakat di PT<br />

PEDOMAN PENELITIAN DAN PENGABDIAN KEPADA MASYARAKAT EDISI X 418

Hooray! Your file is uploaded and ready to be published.

Saved successfully!

Ooh no, something went wrong!