IEF Trisakti University Formulir Wisuda S2

PROGRAM PASCASARJANA
UNIVERSITAS TRISAKTI
_________________________________________________________________________________FORM
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0008____

PENDAFTARAN WISUDA

PROGRAM STUDI : Magister Ilmu Ekonomi Konsentrasi Ekonomi dan Keuangan Syariah

1.

Nama

:_______ _____________________________________(lengkap dg gelar S1)

2.

NIM/NIRM

: __________________________________________________________

3.

Alamat

: ________ _______________________________________________________
: _________________________________________________________

4.

Telepon Rumah

: _____________________

Telp. Kantor : ______________________

5.

Tempat & Tanggal Lahir

: __________________________________________________________

6.

Agama

: __________________________________________________________

7 . Jenis Kelamin

: __________________________________________________________

8 . Konsentrasi

: ___________________________________________________________

9.

: __________________________

Nama Ayah

10. Judul Tesis (B. Indonesia)

Nama Ibu:_____________________

:__________________________________________________________
____________________________________________________________

11. Judul Tesis (Bhs.Inggris)

:______________________________________________________
_________________________________________________________________

12. Ukuran Toga

: __________________________________________________________

Jakarta,

20…

Mahasiswa yang bersangkutan,

( _____________________________ )

Catatan : Lampirkan Pasphoto terbaru (berlatar belakang warna Merah) ukuran 3 x 4 sebanyak 7 Lembar.