Nama : ..........................................................................................................................
Instansi/Lembaga : ..........................................................................................................................
Alamat Kantor : ..........................................................................................................................
: ..........................................................................................................................
Jabatan : ..........................................................................................................................
No. HP : ..........................................................................................................................
Bersedia menerima mahasiswa/i Fakultas Ekonomi dan Bisnis Islam UIN Mataram, sejumlah
.................... orang untuk melaksanakan Praktik Kerja Lapangan di ..................................................
selama kurang lebih 2 bulan.
Demikian formulir ini kami sampaikan, untuk dapat dipergunakan sebagaimana mestinya.
Mataram,.............................. 2020
Pimpinan/ Pejabat
.............................................