format surat pengantar

KEMENTERIAN PENDIDIKAN NASIONAL

N E G E

UNIVERSITAS NEGERI MALANG (UM)

I

ER SITA

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S

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IV

M A L
A

FAKULTAS EKONOMI

Jalan Surabaya 6 Malang 65145  Telp. (0341) 551-312 psw 271  Telp./Fax. (0341) 552-888 (langsung)

Website: http://www.um.ac.id  E-mail: rektorat@malang.ac.id

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FORM PERMOHONAN SURAT PENGANTAR
Yth. Bapak Pembantu Dekan I
Fakultas Ekonomi – Universitas Negeri Malang
Mohon dapatnya dibuatkan surat pengantar untuk keperluan:
(Lingkari didepan pilihan yang sesuai)

 Observasi/penelitian Skripsi
 Observasi/penelitian Tugas Akhir (TA)
 Observasi/penelitian

tugas

matakuliah:

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 Kuliah Kerja Lapangan (KKL)
 Praktek Kerja Lapangan (PKL)
Nomor Surat : ............../H32.4.1/DT/2010
Nama

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Anggota

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Jurusan

:

Manajemen / Akuntansi / Ekonomi Pembangunan *)

Program Studi

:

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Yang dituju

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(Nama Pimpinan & Lembaga/Instansi harus jelas)

Alamat yang dituju

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Tempat Penelitian

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Waktu (Tanggal & Bulan) :

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Judul Karya Tulis

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Dosen Pembimbing

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1.

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Mengetahui:
Ketua Jurusan ........................................,

Malang, ........................................ 2010
Mahasiswa Pemohon,

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NIP.

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NIM.

Keterangan:
*) Coret yang tidak perlu