FORM PENGAJUAN JUDUL SKRIPSI MAHASISWA

1. Identitas Mahasiswa
Nama Mahasiswa : ...............................................................................
NIM mahasiswa : ..............................................................................
Jurusan/Prodi : Ushuluddin/ IQT
Jumlah SKS diperoleh...................SKS
Judul Proposal yang diajukan:

a. ....................................................................................................................................................................................................
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b. ....................................................................................................................................................................................................
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c. ....................................................................................................................................................................................................
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Telah dilakukan verifikasi kesamaan judul proposal di atas oleh Verifikator Prodi IQT:
Verifikator,

Ilham Syukri, Lc, M.A

NIP. 198512292019031005
2. Proses Konsultasi
a. Rekomendasi Verifikasi Program Studi
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b. Rekomendasi PA
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c. Rekomendasi Dosen
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d. Persetujuan Koordinator Prodi/ Sekretaris Jurusan Ushuluddin

Setelah melakukan konsultasi judul dengan PA, Verifikator judul, dan Dosen Prodi maka judul
proposal yang diajukan adalah:
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Mahasiswa Bengkulu,.................................20
Koprodi IQT/ SekJur Ushuluddin

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NIM NIP.