Formulir Pendaftaran Munaqasyah

FORMULIR PENDAFTARAN MUNAQOSYAH
FAKULTAS EKONOMI DAN BISNIS ISLAM
IAIN SURAKARTA
A. Data Mahasiswa
1. Nama

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

2. NIM

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

3. Tempat/Tanggal Lahir : .................................................................................................................
4. Jurusan/Prodi

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

5. Judul Skripsi *

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

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

6. Tanggal Munaqosyah : .................................................................................................................
7. Alamat :
a. Rumah

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

b. Kos/Sementara

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

c. Telepon/ HP

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

(Alamat di tulis lengkap RT, RW, Nomor Rumah, Kode Pos)

* bagi mahasiswa program S – 1
B. Data Orang Tua
1. Nama Bapak dan Ibu : .................................................................................................................
2. Pekerjaan

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

3. Alamat

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

(Alamat di tulis lengkap RT, RW, Nomor Rumah, Kode Pos)

Surakarta, .........................20
Peserta Munaqosyah,

.................................................
NIM (
)

foto
ditempel
disini