Anda di halaman 1dari 1

FORM PERMOHONAN SIDANG UNIVERSITAS PELITA HARAPAN

AJR-16/FRM-04/REV-02

Pendaftaran Ujian Sidang Tugas Akhir

Nama Mahasiswa : .........................................................................................................................


NPM : .........................................................................................................................
Jurusan : .........................................................................................................................
Fakultas : .........................................................................................................................
Dosen Pembimbing : .........................................................................................................................
..........................................................................................................................
..........................................................................................................................
..........................................................................................................................
Dosen Co-Pembimbing : .........................................................................................................................
Judul Tugas Akhir : .........................................................................................................................
Hari/Tanggal Ujian *) : .........................................................................................................................
Waktu *) : ...........................................................WIB

Karawaci, …………………..

( )
Nama mahasiswa

Keterangan :
*) diisi oleh petugas

Anda mungkin juga menyukai