KEMENTERIAN AGAMA REPUBLIK INDONESIA

INSTITUT AGAMA ISLAM NEGERI TULUNGAGUNG

FAKULTAS EKONOMI DAN BISNIS ISLAM
Jalan Mayor Sujadi Timur Nomor 46 Tulungagung - Jawa Timur 66221
Telepon (0355) 321513, 321656 Faximile (0355) 321656
Website : http://iain-tulungagung.ac.id

PENDATAAN ALUMNI FAKULTAS EKONOMI DAN BISNIS ISLAM

NOMOR :_____________

NAMA :____________________________________________________

TEMPAT / TGL LAHIR :____________________________________________________

JURUSAN / PRODI :____________________________________________________

TAHUN MASUK :____________________________________________________

TAHUN LULUS :____________________________________________________

ALAMAT

RT / RW :_________________________________________________
Dusun :_________________________________________________
Desa :_________________________________________________
Kecamatan :_________________________________________________
Kabupaten/Kota :_________________________________________________
Propinsi :_________________________________________________
Nomor Telp/HP :_________________________________________________

PEKERJAAN
A. PNS/TNI/POLRI
1. NIP/NIK :_____________________________________________
2. Instansi :_____________________________________________
3. Jabatan :_____________________________________________
4. Alamat Instansi :_____________________________________________

B. Guru/Karyawan Swasta
1. Instansi/Perusahaan :_________________________________________
2. Jabatan :_________________________________________
3. Alamat Instansi :_________________________________________

C. Wirausaha
1. Jenis Usaha :_________________________________________
2. Alamat Usaha :_________________________________________

D. Lainnya :_________________________________________

Tulungagung, ____________________

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