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KEMENTERIAN RISET, TEKNOLOGI DAN PENDIDIKAN TINGGI

UNIVERSITAS JENDERAL SOEDIRMAN


FAKULTAS TEKNIK
Jl. Mayjend Sungkono Km 5, Blater, Purbalinga 53371 Telp. (0281) 6596700
Faks (0281) 6596801 Laman : ft.unsoed.ac.id Email : ft@unsoed.com

Daftar Isian Mahasiswa untuk keperluan SKPI (Surat Keterangan Pendamping Ijazah)
1. NIM : ......................................................................................
2. NAMA MHS : ......................................................................................
3. TEMPAT/TGL LAHIR : ......................................................................................
4. TAHUN MASUK :......................................................................................
5. PRODI : ......................................................................................
6. PENGHARGAAN DAN PEMENANG KEJUARAAN (PRESTASI) :
Nama Kejuaraan /Prestasi / Penghargaan
No
(dalam Bhs Indonesia dan Bhs Inggris)

7. SEMINAR NASIONAL/INTERNASIONAL
Seminar Nasional/Internasional
No
(dalam Bhs Indonesia dan Bhs Inggris)

8. PENGALAMAN ORGANISASI
Nama Organisasi
No
(dalam Bhs Indonesia dan Bhs Inggris)

9. JUDUL TUGAS AKHIR ( BHS INDONESIA DAN BHS INGGRIS)


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10. BAHASA INTERNASIONAL ( MISAL TOEFL)

No Keterangan
11. JUDUL MAGANG / KP ( BHS IND & BHS INGGRIS)
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12. Soft Skill Training / Pendidikan Karakter ( BHS IND & BHS INGGRIS)
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