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Formulir Pendaftaran Calon Peserta MMA-IPB Hal dari 6 1
Nama Lengkap : ........................................................................................................................................................ (sesuai dengan ijazah S1)
Gelar Kesarjanaan : ........................................................................................................................................................
Tempat / Tanggal Lahir : ........................................................................................................................................................
Agama : ................................................................................................ Jenis Kelamin : ( L / P )
Status Perkawinan : Menikah Belum Menikah
Alamat Rumah/Korespondensi : ........................................................................................................................................................
........................................................................................................................................................
Telp. ( ..............) .................................................. HP ...............................................................
Email : ...................... ...................................................................................................................
Alamat Kantor : .......................................................................................................................................................
.......................................................................................................................................................
Telp. ( ..............) ................................................. HP ...............................................................
Email : .........................................................................................................................................
Nama Perguruan Tinggi (S1) : ..................................................................................................................................................
Fakultas/Jurusan : ....................................................................................... IPK : ...............................................
Pendidikan lain yang diperoleh : ..................................................................................................................................................
Penghargaan Akademik : ..................................................................................................................................................
..................................................................................................................................................
I. DATA PRIBADI
II. LATAR BELAKANG AKADEMIK
FORMULIR PENDAFTARANPROGRAM MAGISTER MANAJEMEN AGRIBISNIS
No. Tes : ..............................................
Foto4 cm x 6 cm
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Formulir Pendaftaran Calon Peserta MMA-IPB Hal dari 6 2
Kemampuan Bahasa Asing :
Tes yang pernah diikuti :
(Ditulis secara kronologis, bila diperlukan dapat menggunakan lembar tersendiri)
1. Motivasi Saudara mengikuti Program MMA-IPB
Lama KerjaNama Instansi Jabatan
Dari tahun Sampai dengan tahun
................... ..................... ..................... . ...................... ..................... .................. ....... ..................... .................... ..................... ...
................... ..................... ..................... . ...................... ..................... ................... ..................... ....... .................... ..................... ...
................... ..................... ..................... . ...................... ..................... ................... ..................... ....... .................... ..................... ...
................... ..................... ..................... . ...................... ..................... ................... ..................... ....... .................... ..................... ...
................... ..................... ..................... . ...................... ..................... ................... ..................... ....... .................... ..................... ...
................... ..................... ..................... . ...................... ..................... ................... ..................... ....... .................... ..................... ...
................... ..................... ..................... . ...................... ..................... ................... ..................... ....... .................... ..................... ...
III. PENGALAMAN PEKERJAAN
IV. MOTIVASI DAN HARAPAN
Bahasa Membaca* Berbicara * Menulis*
1. .......................... ................... .............. ........................... ...... .................... .............
2. .......................... ................... .............. ........................... ...... .................... .............
3. .......................... ................... .............. ........................... ...... .................... .............
* Diisi dengan pilihan: SB = Sangat Baik; B = Baik; C = Cukup; K = Kurang
Jenis Tanggal Nilai
TOEFL ...................................................................................... ..................................
GMAT ...................................................................................... ..................................
TPA ...................................................................................... ..................................
...................................................................................................................................................................................................................
...................................................................................................................................................................................................................
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...................................................................................................................................................................................................................
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Formulir Pendaftaran Calon Peserta MMA-IPB Hal dari 6 3
2. Karir apa yang akan Bapak/Ibu kembangkan setelah menyelesaikan Program MMA-IPB ?
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 dipergunakanformulir yang telah disediakan.
Pemberi rekomendasi
Status : Atasan
Nama Lengkap : ........................................................................................................................................................................
Pekerjaan : ........................................................................................................................................................................
Alamat Kantor : .......................................................................................................... Telp. : ( ............... )............................
Pemberi rekomendasi
Status : Dosen Pembimbing
Nama Lengkap : ........................................................................................................................................................................
Pekerjaan : ........................................................................................................................................................................
Alamat Kantor : .......................................................................................................... Telp. : ( ............... )............................
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 :
........................................................................................
V. REFERENSI
VI. PERNYATAAN PELAMAR
...................................................................................................................................................................................................................
...................................................................................................................................................................................................................
...................................................................................................................................................................................................................
...................................................................................................................................................................................................................
...................................................................................................................................................................................................................
........................................................................................................................................................................................ .......
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Formulir Pendaftaran Calon Peserta MMA-IPB Hal dari 6 4
R A H A S I A
PROGRAM MAGISTER MANAJEMEN AGRIBISNISSURAT REKOMENDASI
(Diperlukan untuk pendaftaran ke Program Studi Magister Manajemen Agribisnis IPB)
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 ProgramMagister 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 ?
..................................................................................................................................................................................................................
..................................................................................................................................................................................................................
..................................................................................................................................................................................................................
Pemberi Rekomendasi
Nama : ..................................................................................................................................
Jabatan/Pangkat : ..................................................................................................................................
Nama Institusi : ..................................................................................................................................
Alamat Kantor : ..................................................................................................................................
.................................................................................................................................
Telp. (.............) ......................................................................................................
Calon Pendaftar
Nama : ..................................................................................................................................
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Formulir Pendaftaran Calon Peserta MMA-IPB Hal dari 6 5
5. Gunakan pilihan berikut ini untuk menilai calon peserta (beri tanda silang pada peringkat yang saudara pilih)
Baiksekali
Baik Rata-Rata Kurang Tidakdapat
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
(..................................................................)
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Formulir Pendaftaran Calon Peserta MMA-IPB Hal dari 6 6
KELENGKAPAN PERSYARATANLAMARAN 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).
