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FORM LAYANAN KELUHAN SUBDOMAIN DAN WEBSITE
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TANGGAL PENGAJUAN FORMULIR
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Diisi dengan tanggal saat formulir ini diisi
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Nama Lembaga/Unit/Jurusan/Prodi/Ormawa
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PENANGGUNG JAWAB
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NIP/NIM
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UNIT KERJA
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Jika Anda Mahasiswa, isi dengan hanya garis mendatar (-)
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JABATAN
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NOMOR TELEPON AKTIF
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NAMA SUBDOMAIN
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JENIS KELUHAN
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Jenis keluhan dapat diceritakan secara ringkas dan jelas
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