Nama Mahasiswa :
NIM :
Hari/Tanggal :
No Kegiatan Hasil Kendala Tindak Lanjut
(...........................................................) (....................................................)
NIP. NIM.
Mengetahui,
Pembimbing Institusi
(........................................................)
NIDN.
Kelompok :
Instansi tempat PKL :
Nama Pembimbing Lahan :
(...........................................................) (....................................................)
NDN. NIP.