Form Pendaftaran Wisuda

FORMULIR PENDAFTARAN WISUDA
FAKULTAS DAKWAH DAN KOMUNIKASI UIN WALISONGO
Nomor Urut

: ............(diisi petugas)

Nama Lengkap (sesuai ijasah) : ..........................................................................................................
NIM

: ..........................................................................................................

Jurusan/Konsentrasi

: ..........................................................................................................

TTL

: ..........................................................................................................

(sesuai ijasah)

Alamat Semarang (diisi lengkap)..........................................................................................................:
: ..........................................................................................................
No. Telp/HP

: ..........................................................................................................

Nama Orang Tua

: a. Bapak : ......................................................................................
b. Ibu

: ......................................................................................

Alamat Orang Tua (diisi lengkap).........................................................................................................:
: ..........................................................................................................
No Telp/HP Orang Tua

: ..........................................................................................................

Tanggal Lulus

: ..........................................................................................................

IPK

: ..........................................................................................................

Judul Skripsi

: ..........................................................................................................
..........................................................................................................
..........................................................................................................
Semarang,
………………………………………
Calon Wisudawan

______________________________

Catatan:
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