Lampiran 4.

FORMAT SURAT PERSETUJUAN PROMOTOR

KOP SURAT PERGURUAN TINGGI

SURAT PERNYATAAN
KESEDIAAN SEBAGAI PEMBIMBING UTAMA (PROMOTOR) PESERTA
PROGRAM BELAJAR BERBASIS RISET

Yang bertanda tangan di bawah ini:

Nama : ...............................................................................................................................................
NIP/NIDN : ...............................................................................................................................................
Fakultas : ...............................................................................................................................................
Perguruan Tinggi : ...............................................................................................................................................

bersedia menjadi Pembimbing Utama (Promotor) bagi peserta program belajar berbasis riset :
Nama : ...............................................................................................................................................
NIP/NIK : ...............................................................................................................................................
Jabatan : ...............................................................................................................................................
Satuan Kerja : ...............................................................................................................................................
Jenjang : S2 / S3 (pilih salah satu)
Perguruan Tinggi : ...............................................................................................................................................
Program Studi : ...............................................................................................................................................
Co-Promotor : ...............................................................................................................................................
Judul Proposal Penelitian : ...............................................................................................................................................
...............................................................................................................................................
...............................................................................................................................................
...............................................................................................................................................

Demikian surat pernyataan ini dibuat untuk dapat dipergunakan sebagaimana mestinya.

………………, ……………………………….. 2022

Pembimbing Pendamping, Pembimbing Utama,

Ttd Ttd

Nama Nama
NIP/NIDN. NIP/NIDN.