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YAYASAN NURUSSALAM

INSTITUT PESANTREN MATHALI’UL FALAH


Jl. Pati-Tayu KM. 20 Purworejo Margoyoso Pati Jawa Tengah 59154
Telp. (0295) 550-1999 Fax. (0295) 415-0081 Email:
info@ipmafa.ac.id

FORMULIR PENGAJUAN JUDUL SKRIPSI

Nama : ........................................................................................... ..........


NIM : ........................................................................................... ..........
Jurusan/ Prodi : ........................................................................................... ..........
Semester : ........................................................................................... ..........

Judul yang diajukan *):


1. .......................................................................................................................................
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2. .......................................................................................................................................
.......................................................................................................................................
3. .......................................................................................................................................
.......................................................................................................................................
Judul yang disetujui :
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Catatan Dosen Pembimbing Akademik:
.............................................................................................................................................
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.............................................................................................................................................

Pati, ............................20.....
Dosen Pembimbing Akademik: Mahasiswa pengusul:

(..............................................) (...........................................)

*) Mahasiswa berhak mengajukan maksimal 3 alternatif judul.

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