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FORMULIR PENDAFTARAN MAGANG KERJA

Semester Ganjil Tahun Ajaran 2020/2021

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


NIM : .....................................................
Tempat/Tanggal Lahir : .....................................................
Jurusan : .....................................................
Program Studi : .....................................................
Perolehan SKS : .........................
IP. Kumulatif : .........................
Alamat Asal : ............................................................................
............................................................................
No. Telefon/HP. : ............................................................................
Lokasi Magang Kerja* : ............................................................................
............................................................................
* Coret salah satu : (Lokasi terdaftar / Belum terdaftar)
Alamat Lokasi Magang : ............................................................................
............................................................................
............................................................................
Alamat Tujuan Surat : ............................................................................
............................................................................
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Komoditi : ..............................................

Malang,
Mengetahui Mahasiswa,
Dosen Pembimbing Magang,

NIP. NIM.

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