FAKULTAS ILMU TERAPAN

UNIVERSITAS TELKOM

BIODATA PEMBIMBING TA / PA

N AM A : .........................................................................................

NIP / N IK : .........................................................................................

TEMPAT TGL LAHIR :..........................................................................................

NAMA INSTANSI : .........................................................................................

JABATAN AKADEMIK : .............................................................................................................

TINGKAT / GOL ONGAN : ............................................................................................................

ALAMAT RUMAH : ............................................................................................................

PENDIDIKAN TERAKHIR :.................................................................................

RIWAYAT PEKERJAAN : ............................................................................................................

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NAMA B ANK & NO REKENING : ............................................................................................................

MATA KULIAH YANG : ............................................................................................................

PERNAH DIAJARKAN .........................................................................................
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PEMBIMBING DARI MAHASISW A NAMA / NIM :… ……… ……… ……… ………......../..........................

Bandung , ...................................

Pembimbing TA / PA

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