Nama : ..............................................................................................
NIM : ..............................................................................................
No.Telp. : ..............................................................................................
Fakultas : Tarbiyah dan Ilmu Keguruan
Prodi : Pendidikan Agama Islam
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Judul Proposal : ..............................................................................................
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Pembimbing I : ..............................................................................................
Pembimbing II : ..............................................................................................
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Penguji II : ..............................................................................................
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Jam : ..............................................................................................
Tempat Ujian : ..............................................................................................