KOLEGIUM MAHASISWA

DEWAN PERWAKILAN MAHASISWA

FAKULTAS KEDOKTERAN UNIVERSITAS BRAWIJAYA
Jl. Mayjen Haryono 171 Kampus Sumbersari Malang 65145
Telp. (0341) 569117,567192-Fax. (0341) 564755
Email:dpmfk@ub.ac.id

FORM SC
Saya yang bertandatangan dibawah ini:
Nama :
Jur/ang:
Merupakan SC dari proker.....................................lembaga...............................
1. Menurut Anda, berapa persentase ketercapaian hasil dari proker ini? Jelaskan
alasannya!
..........................................................................................................................................
..........................................................................................................................................
..........................................................................................................................................
..........................................................................................................................................
2. Secara garis besar, apa kekurangan dan kelebihan dari proker yang sudah berjalan ini?
..........................................................................................................................................
..........................................................................................................................................
..........................................................................................................................................
..........................................................................................................................................
...........................................
3. Menurut Anda, apakah dana yang digunakan untuk menjalankan proker ini termasuk
kategori berlebihan, cukup atau kurang?
..........................................................................................................................................
..........................................................................................................................................
Apakah untuk kepengurusan selanjutnya proker ini masih harus dipertahankan?
Jelaskan alasannya!
..........................................................................................................................................
..........................................................................................................................................
..........................................................................................................................................
..........................................................................................................................................
..........................................................................................................................................

.................,.......................

TTD
(Nama terang)
Religius, Moralis , Intelek, Profesional