Formulir Pengajuan Cuti
Formulir Pengajuan Cuti
Kepada Yth. :
Dekan Fakultas Teknik
Universitas Gadjah Mada
Jl. Grafika No. 2 Yogyakarta
: .....................................................................
No. Mhs.
: .....................................................................
Instansi Asal
: .....................................................................
Program Studi
: .....................................................................
Minat
: .....................................................................
Biaya Studi
Alamat lengkap
: .....................................................................
No Telepon/HP
: .....................................................................
Alasan cuti
: .....................................................................
.....................................................................
Nama :
Mengetahui,
Pengelola S2 Teknik Elektro UGM
Dosen Pembimbing
.....................................
NIP.
Melalui surat ini saya mahasiswa Program Studi S3 (Doktor) Teknik Elektro :
Nama Lengkap
: .....................................................................
No. Mhs.
: .....................................................................
Instansi Asal
: .....................................................................
Program Studi
: .....................................................................
Minat
: .....................................................................
Biaya Studi
Alamat lengkap
: .....................................................................
No Telepon/HP
: .....................................................................
Alasan cuti
: .....................................................................
.....................................................................
bermaksud mengajukan ijin cuti/tidak aktif mengikuti kegiatan akademik Program Studi
S3 (Doktor) Teknik Elektro selama :
) semester.
Semester
: ........ (
Mulai Tahun Akademik : ........s/d ..........
Berikut saya lampirkan :
1. Lunas SPP semester terakhir.
2. Surat pernyataan tidak sedang menerima BPPS.
Demikian permohonan ini disampaikan dan atas perhatiannya saya ucapkan terima kasih.
Yogyakarta,
Nama :
Mengetahui,
Pengelola S3 Teknik Elektro UGM
Dosen Pembimbing
.....................................
NIP.