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Ministry ofEducationAnd Culture KementerianPendidikanDanKebudayaan

University of Malikussaleh UniversitasMalikussaleh


Medical School Program StudiPendidikanDokter
Jl. H. MeunasahUteunkot CundaLhokseumawe Jl. H. MeunasahUteunkot CundaLhokseumawe
Nanggroe Aceh Darussalam Indonesia Nanggroe Aceh Darussalam Indonesia
Phone : +645 40549 Phone : +645 40549
e-mail : info@pspd.unimal.ac.id e-mail : info@pspd.unimal.ac.id

FORM LAPORAN DISTRIBUSI SKRIPSI


PROGRAM STUDI PENDIDIKAN DOKTER

Nama : ....................................................................................................................................
Nim : ....................................................................................................................................
Judul Skripsi : ....................................................................................................................................
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Tujuan Tanggal
No Penerima Tanda Tangan
Distribusi Terima

Pustaka
1 Universitas
Malikussaleh

Pustaka PSPD
2
UNIMAL

Dosen
3
Pembimbing

Mengetahui,
Ketua PSPD Koordinator Pengelola Skripsi
PSPD

dr.Cut Khairunnisa, M.Kes dr. Zubir, M.Biomed


NIP. 19820312 200912 2 004 NIP.19790804 200912 1 001

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