uui lembar bebas akademik

Rangkap 1 :
1. DAA

UNIVERSITAS
UBUDIYAH INDONESIA

FORMULIR 1
SURAT KETERANGAN BEBAS AKADEMIK, KEUANGAN DAN KEMAHASISWAAN
SEMINAR PROPOSAL
Nama
Nim
Prodi
Fakultas
Alamat

: …………………………………………………………..
: …………………………………………………………..
: …………………………………………………………..
: …………………………………………………………..
: …………………………………………………………..


1. Keterangan Bebas Akademik
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Catatan :
SKS sudah mencukupi (Semua mata kuliah sudah diambil kecuali tugas akhir/skripsi)
Tidak ada Nilai D
…………………………………………………………………………………………………….….
Banda Aceh,
……………………………………………………
Dir. DAA
Ka. Prodi
……………………………………

………………………………………

2. Keterangan Bebas Pinjaman Buku Perpustakaan
Catatan : .......................................................................................................................
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.......................................................................................................................
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Banda Aceh,
……………………………………………………
Ka. Perpustakaan,
……………………………………………………

3. Keterangan Lunas Keuangan
Catatan : ...................................................................................................................
....................................
............................................................................................................................
...........................
Banda Aceh,
……………………………………………………
Bag.
Keuangan,
……………………………………………

4. Keterangan Bebas Pinjaman Alat Laboratorium
Catatan : .......................................................................................................................
................................
.............................................................................................................................

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Banda Aceh,
……………………………………………………
Ka. Lab
………….......................,

……………………………………………

5. Keterangan Bebas Kepengurusan UKM/UBM/DLL
Catatan : .......................................................................................................................
..........................
..............................................................................................................................
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Banda Aceh,
……………………………………………………
Direktur Kemahasiswaan,
……………………………………………
Catatan : - Persetujuan ditandatangani pejabat yang berwenang dan dibubuhi stempel
DAA2017

-Persetujuan Ka. Lab disesuaikan dengan prodi masing-masing