Data Form Perwalian
Data Form Perwalian Mahasiswa Teknik Elektronika PENS

*Data hasil isian akan dikirimkan ke email. Silahkan dicetak dan ditandatangani, lalu diserahkan kepada dosen wali

Email address *
1. Nama : *
Your answer
2. NRP : *
Your answer
3. Kelas : *
Your answer
5. Nomor Telepon : *
Your answer
6. Index Prestasi Semester : *
Your answer
7. Total Jam Pelanggaran dalam satu semester : *
Your answer
8. Kegiatan/Perlombaan/Kompetisi yang diikuti di semester sebelumnya :
Your answer
9. Prestasi yang di raih semester sebelumnya :
Your answer
10.Keluhan/Permasalahan yang perlu disampaikan ke Dosen Wali :
Your answer
11. Jumlah NSP :
Your answer
Tanda Tangan Mahasiswa
Surabaya,
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(________________________________________)
NRP.
Validasi Dosen Wali
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(________________________________________)
NIP.
A copy of your responses will be emailed to the address you provided.
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