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DATA WISUDAWAN

Nama Lengkap : .....................................................................................................


Jenis Kelamin : .....................................................................................................
Tempat, Tgl Lahir : .....................................................................................................
NIM : .....................................................................................................
Program Studi : .....................................................................................................
Fakultas : .....................................................................................................
Tanggal Yudisium : .....................................................................................................
Nilai IPK : .....................................................................................................
Judul Skripsi : .....................................................................................................
: .....................................................................................................
.....................................................................................................
Alamat Asal/Daerah : .....................................................................................................
Alamat Palopo : .....................................................................................................
No. Telp/HP : .....................................................................................................
Email : .....................................................................................................
Status : Menikah/Tidak Menikah
Nama Ayah : .....................................................................................................
Nama Ibu : .....................................................................................................
Pekerjaan Orang Tua : .....................................................................................................
Alamat Orang Tua : .....................................................................................................

Nama tersebut di atas telah Palopo,


20_ _
Memenuhi persyaratan wisuda Wisudawan/Alumni,
Ketua Prodi Tadris Matematika,

................................................. ...............................................
NIP. NIM.

Form D9