KEMENTERIAN PENDIDIKAN NASIONAL

N E G E

UNIVERSITAS NEGERI MALANG (UM)

E R S ITA

IV

M A L
A

FAKULTAS EKONOMI

Jalan Surabaya 6 Malang 65145 Telp. (0341) 551-312 psw 271 Telp./Fax. (0341) 552-888 (langsung)

Website: http://www.um.ac.id E-mail: rektorat@malang.ac.id

U N

FORM PERMOHONAN SURAT PENGANTAR

Yth. Bapak Pembantu Dekan I
Fakultas Ekonomi Universitas Negeri Malang
Mohon dapatnya dibuatkan surat pengantar untuk keperluan:
(Lingkari didepan pilihan yang sesuai)

Observasi/penelitian Skripsi
Observasi/penelitian Tugas Akhir (TA)
Observasi/penelitian

tugas

matakuliah:

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Kuliah Kerja Lapangan (KKL)

Praktek Kerja Lapangan (PKL)
Nomor Surat : ............../H32.4.1/DT/2010
Nama

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NIM. .........................................
Anggota

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NIM. .........................................
2. ..................................................................
NIM. .........................................
3. ..................................................................
NIM. .........................................
4. ..................................................................
NIM. .........................................
5. ..................................................................
NIM. .........................................

Jurusan

Manajemen / Akuntansi / Ekonomi Pembangunan *)

Program Studi

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

Yang dituju

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

(Nama Pimpinan & Lembaga/Instansi harus jelas)

Alamat yang dituju

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Tempat Penelitian

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Waktu (Tanggal & Bulan) :

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Judul Karya Tulis

:
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Dosen Pembimbing

Mengetahui:

1.

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2.

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Malang, ........................................ 2010

Ketua Jurusan ........................................,

Mahasiswa Pemohon,

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NIP.

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NIM.

Keterangan:
*) Coret yang tidak perlu