FORMULIR PENDAFTARAN PROGRAM MAGISTER MANAJEMEN AGRIBISNIS
Foto 4 cm x 6 cm
No. Tes : ..............................................
I. DATA PRIBADI Nama Lengkap (sesuai dengan ijazah S1)
: ........................................................................................................................................................
Gelar Kesarjanaan
: ........................................................................................................................................................
Tempat / Tanggal Lahir
: ........................................................................................................................................................
Agama
: ................................................................................................ Jenis Kelamin : ( L / P )
Status Perkawinan
:
Alamat Rumah/Korespondensi
: ........................................................................................................................................................
Menikah
Belum Menikah
........................................................................................................................................................ Telp. ( ..............) .................................................. HP ............................................................... Email : ...................... ................................................................................................................... Alamat Kantor
: ....................................................................................................................................................... ....................................................................................................................................................... Telp. ( ..............) ................................................. HP ............................................................... Email : .........................................................................................................................................
II. LATAR BELAKANG AKADEMIK Nama Perguruan Tinggi (S1)
: ..................................................................................................................................................
Fakultas/Jurusan
: ....................................................................................... IPK : ...............................................
Pendidikan lain yang diperoleh
: ..................................................................................................................................................
Penghargaan Akademik
: .................................................................................................................................................. ..................................................................................................................................................
Formulir Pendaftaran Calon Peserta MMA-IPB
Hal 1 dari 6
Kemampuan Bahasa Asing
:
Bahasa
Membaca*
Berbicara *
Menulis*
1. ..........................
.................................
.................................
.................................
2. ..........................
.................................
.................................
.................................
3. ..........................
.................................
.................................
.................................
* Diisi dengan pilihan: SB = Sangat Baik; B = Baik; C = Cukup; K = Kurang
Tes yang pernah diikuti
:
Jenis
Tanggal
Nilai
TOEFL
......................................................................................
..................................
GMAT
......................................................................................
..................................
TPA
......................................................................................
..................................
III. PENGALAMAN PEKERJAAN (Ditulis secara kronologis, bila diperlukan dapat menggunakan lembar tersendiri)
Nama Instansi
Jabatan
..............................................................
Lama Kerja Dari tahun
Sampai dengan tahun
.............................................................
............................
............................................
..............................................................
..............................................................
............................
............................................
..............................................................
..............................................................
............................
............................................
..............................................................
..............................................................
............................
............................................
..............................................................
..............................................................
............................
............................................
..............................................................
..............................................................
............................
............................................
..............................................................
..............................................................
............................
............................................
IV. MOTIVASI DAN HARAPAN 1.
Motivasi Saudara mengikuti Program MMA-IPB
................................................................................................................................................................................................................... ................................................................................................................................................................................................................... ................................................................................................................................................................................................................... ................................................................................................................................................................................................................... ...................................................................................................................................................................................................................
........................................................................................................................................................................................ .......
Formulir Pendaftaran Calon Peserta MMA-IPB
Hal 2 dari 6
2.
Karir apa yang akan Bapak/Ibu kembangkan setelah menyelesaikan Program MMA-IPB ?
................................................................................................................................................................................................................... ................................................................................................................................................................................................................... ................................................................................................................................................................................................................... ................................................................................................................................................................................................................... ...................................................................................................................................................................................................................
........................................................................................................................................................................................ .......
V. REFERENSI Tuliskan nama atasan Bapak/Ibu (bagi yang telah bekerja) dan/atau dosen pembimbing Bapak/Ibu yang dapat memberikan rekomendasi untuk mendukung pendaftaran Bapak/Ibu. Untuk rekomendasi hendaknya dipergunakan formulir yang telah disediakan. Pemberi rekomendasi Status
: Atasan
Nama Lengkap
: ........................................................................................................................................................................
Pekerjaan
: ........................................................................................................................................................................
Alamat Kantor
: .......................................................................................................... Telp. : ( ............... )............................
Pemberi rekomendasi Status
: Dosen Pembimbing
Nama Lengkap
: ........................................................................................................................................................................
Pekerjaan
: ........................................................................................................................................................................
Alamat Kantor
: .......................................................................................................... Telp. : ( ............... )............................
VI. PERNYATAAN PELAMAR Dengan ini kami mendaftarkan diri pada : PROGRAM MAGISTER MANAJEMEN AGRIBISNIS PROGRAM PASCASARJANA MANAJEMEN DAN BISNIS - IPB dan formulir ini telah kami isi dengan jujur, benar dan lengkap. Nama
: .......................................................................................
Tanggal
: .......................................................................................
Tandatangan :
........................................................................................ Formulir Pendaftaran Calon Peserta MMA-IPB
Hal 3 dari 6
RAHASIA
PROGRAM MAGISTER MANAJEMEN AGRIBISNIS SURAT REKOMENDASI
(Diperlukan untuk pendaftaran ke Program Studi Magister Manajemen Agribisnis IPB)
Pemberi Rekomendasi Nama
: ..................................................................................................................................
Jabatan/Pangkat : .................................................................................................................................. Nama Institusi
: ..................................................................................................................................
Alamat Kantor
: .................................................................................................................................. ................................................................................................................................. Telp. (.............) ......................................................................................................
Calon Pendaftar Nama
: ..................................................................................................................................
1. Sudah berapa lama Bapak/Ibu mengenal calon peserta, dan dalam hubungan apa ? .................................................................................................................................................................................................................. .................................................................................................................................................................................................................. .................................................................................................................................................................................................................. 2. Apakah menurut Bapak/Ibu calon peserta mempunyai kemampuan untuk mengikuti dan menyelesaikan Program Magister Manajemen Agribisnis IPB ? .................................................................................................................................................................................................................. .................................................................................................................................................................................................................. .................................................................................................................................................................................................................. 3. Menurut pandangan Bapak/Ibu, dalam hal-hal apa calon peserta dianggap menonjol ? .................................................................................................................................................................................................................. .................................................................................................................................................................................................................. .................................................................................................................................................................................................................. 4. Dalam hal-hal apa Bapak/Ibu menganggap calon peserta memiliki kelemahan ? .................................................................................................................................................................................................................. .................................................................................................................................................................................................................. ..................................................................................................................................................................................................................
Formulir Pendaftaran Calon Peserta MMA-IPB
Hal 4 dari 6
5. Gunakan pilihan berikut ini untuk menilai calon peserta (beri tanda silang pada peringkat yang saudara pilih)
Baik sekali
Baik
Rata-Rata
Kurang
Tidak dapat menilai
Kemampuan analitik
..............
..............
..............
..............
..............
Kemampuan konseptual
..............
..............
..............
..............
..............
Komunikasi lisan
..............
..............
..............
..............
..............
Komunikasi tertulis
..............
..............
..............
..............
..............
Inisiatif
..............
..............
..............
..............
..............
Kesungguhan
..............
..............
..............
..............
..............
Kemandirian
..............
..............
..............
..............
..............
Kemampuan mengatur penggunaan waktu
..............
..............
..............
..............
..............
Peluang berhasil dalam studi
...............
...............
.............
..............
..............
Berdasarkan informasi diatas, (No. 5) saya merekomendasikan / tidak merekomendasikan *) Calon yang bersangkutan.
Keterangan *) Coret yang tidak perlu.
..........................., ....................................................... Pemberi Rekomendasi
(..................................................................)
Formulir Pendaftaran Calon Peserta MMA-IPB
Hal 5 dari 6
KELENGKAPAN PERSYARATAN LAMARAN CALON PESERTA 1. Fotokopi ijazah dan transkrip nilai S1 dari berbagai disiplin ilmu yang telah dilegalisir oleh Perguruan Tinggi asal, masing-masing satu lembar. 2. Mengisi formulir pendaftaran secara lengkap dengan menyertakan pasphoto berwarna 4 x 6 cm (2 lembar). 3. Surat rekomendasi dari atasan dan/atau dosen pembimbing S1. 4. Surat ijin / cuti belajar dari pimpinan instansi tempat calon peserta bekerja (bagi peserta kelas reguler yang sedang bekerja). 5. Menyelesaikan biaya pendaftaran. 6. Mengikuti Tes Penerimaan (Tes Potensi Akademik, Tes Psikologi, dan Tes Bahasa Inggris yang meliputi listening, vocabulary and reading ). 7. Mengikuti Tes Diagnostik dengan Materi: Pengantar Ekonomi, Pengantar Matematika dan Statistika, Dasar-Dasar Akuntansi, dan Aplikasi Komputer (Tes Diagnostik dimaksudkan untuk menentukan mata kuliah yang harus diikuti oleh calon peserta pada periode matrikulasi).
Formulir Pendaftaran Calon Peserta MMA-IPB
Hal 6 dari 6
