IDENTITAS PESERTA PROGRAM

MAGANG II TAHUN AKADEMIK

2020/2021

A. IDENTITAS MAHASISWA
1. Namalengkap :.............................................................................
2. NPM :.............................................................................
3. Programstudi :.............................................................................
4. Alamat :.............................................................................
5. NomorTelp/Hp :.............................................................................

B. KETERANGAN PROGRAMMAGANG
1. NamaDosenPembimbing :.............................................................................
2. Sekolah Mitra :.............................................................................
3. AlamatSekolah Mitra :.............................................................................
4. Nama Kepala Sekolah Mitra :.............................................................................
5. Guru Pembimbing :.............................................................................

Medan,
Mahasiswa Peserta Magang II

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NPM................................