Formulir Pendaftaran Seminar Proposal

YAYASAN KUTAI KARTANEGARA
(AKTE NOTARIS NOMOR : 46, Tanggal 9 Pebruari 2011)

UNIVERSITAS KUTAI KARTANEGARA

FAKULTAS AGAMA ISLAM
STATUS TERAKREDITASI NOMOR : 0995/SK/BAN-PT/Akred/VI/2016
Jl. Gunung Kombeng No. 27 Telp. (0541) 6666369 PO Box 133 Tenggarong ; Kalimantan Timur

FORMULIR PENDAFTARAN
SEMINAR PROPOSAL
FAKULTAS AGAMA ISLAM
Nama

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

N.P.M

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

Alamat

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

No. Telephone

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

Judul Proposal

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

Pembimbing

: 1. .............................................................................................................
2. .............................................................................................................

Tenggarong, .......................................20.....

Pendaftar,

Catatan :
Lampirkan fotocopy kuitansi pembayaran proposal sebanyak 1 lembar.

YAYASAN KUTAI KARTANEGARA
(AKTE NOTARIS NOMOR : 46, Tanggal 9 Pebruari 2011)

UNIVERSITAS KUTAI KARTANEGARA

FAKULTAS AGAMA ISLAM
STATUS TERAKREDITASI NOMOR : 0995/SK/BAN-PT/Akred/VI/2016
Jl. Gunung Kombeng No. 27 Telp. (0541) 6666369 PO Box 133 Tenggarong ; Kalimantan Timur

Tenggarong,............................20....
Perihal

: Mohon Dijadualkan Seminar
Proposal Skripsi
Kepada Yth,

Wakil Dekan I
Cq. Ketua Program Studi
DiTenggarong

Yang bertanda tangan dibawah ini :
Nama

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

Tempat/Tanggal Lahir : ...............................................................................................................
N.P.M

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

Jurusan

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

Program Studi

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

Alamat

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

Judul Proposal

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

Dengan Dosen Pembimbing sebagai berikut :
1. ..................................................................
2. ..................................................................
Maka dengan ini saya mohon untuk dijadualkan untuk Seminar Proposal Skripsi
sebagaimana perihal diatas.
Demikian surat permohonan ini kami sampaikan, ats perhatian dan perkenannya diucapkan

terima kasih.
Pemohon,

....................................