FORMPERMOHONAN SURAT MAGANG

  1. Yth. (Nama Jabatan jelas)        :        ...............................................................................
  2. (Nama instansi jelas)                :        ...............................................................................
  3. Alamat                                    :        ...............................................................................

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

  1. Kota                                  :        ...............................................................................
  2. Nama Mahasiswa                        :        ................................................................................
  3. NPM/IPK                          :        ................................................................................
  4. Program Studi                          :        ................................................................................
  5. Nomor HP Mahasiswa                :        ...............................................................................
  6. E-mail Mahasiswa                :        ...............................................................................
  7. Jenjang Sarjana                    :        ..............................................................................
  8. Dosen Pembimbing                     :        ...............................................................................
  9. Nomor HP Dosen Pembimbing        :        ...............................................................................                  
  10. Tempat magang pada bagian/divisi         .......................................................................

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

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

  1. Periode/Pelaksanaan Magang          :        ...............................................................................
  2. Keterangan/tautan (link)informasi        :        ...............................................................................

CATATAN:                                                        Jatinangor, ...................................

HARAP DITULIS DENGAN BENAR                        Pemohon,

DAN JELAS

TGL.DIBUAT

TGL/ PENGAMBILAN

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

                                                                NPM  ...........................................