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F‐016 

 
Sekolah Tinggi Teknik Surabaya
  Jalan Ngagel Jaya Tengah 73 – 77, Surabaya 60284 , Indonesia
Telp. (031) 5027920  Fax. (031) 5041509 
 

PROPOSAL WORKSHOP / PROYEK *) 
 
Nama Mahasiswa     : ___________________________________________________________ 
NRP Mahasiswa    : ___________________ 
Nama Mata Kuliah    : ___________________________________________________________ 
Judul Workshop    :  
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Pembimbing   : ____________________________________________________________ 
 

Menyetujui,    Surabaya, ____________________ 
Ketua Jurusan  Pembimbing  Pemohon 
     
     
     
     
(_________________________)  (_________________________)  (_________________________) 

KEPUTUSAN USULAN : DISETUJUI / DITOLAK *) 
Pembimbing : ______________________________________________________________________
Bagian yang harus diperbaiki / ditambahkan : 
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*) Coret yang tidak perlu 
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BAA ‐ (16‐06‐2010) ‐ Proposal Workshop v2 F‐016.doc  

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