SURAT PERNYATAAN PENGGANTIAN DINAS

Dengan ini menyatakan mahasiwa/mahasiswi Politeknik Kesehatan Kemenkes Makassar atas

nama :

Nama .............................................................................................................
NIM .............................................................................................................
Prodi .............................................................................................................
Semester .............................................................................................................
Ruangan .............................................................................................................
Hari/Tgl .............................................................................................................
Jumlah hari .............................................................................................................
Alasan .............................................................................................................
Mengganti dinas pada :
Hari/Tgl .............................................................................................................
Jumlah hari .............................................................................................................
Keterangan .............................................................................................................

Makassar, ......................................

Mahasiswa

(..........................................)

Mengetahui,

CI LAHAN CI INSTITUSI

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