TANDA TERIMA DAN DAN PENGAMBILAN IJAZAH

NAMA : ............................................................................................................................................
NIM : ............................................................................................................................................
PROGRAM STUDI : ............................................................................................................................................
NO. TELP/WA : ............................................................................................................................................
JUDUL SKRIPSI : ............................................................................................................................................

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1. SKRIPSI
Tanggal Bukti
No Lembaga Tanda Tangan
Penyerahan Dokumen
Print Out
1 Perpustakaan
Skripsi 1 Eks.
Soft-Copy
Lembaga Penelitian dan Pengabdian
2 Skripsi
Masyarakat (LPPM)
(CDRW)

2. KEUANGAN
Tanggal
No Bukti Pembayaran Tanda Tangan Keterangan
Penyerahan
Lunas / Tidak
1 Wisuda
Lunas

3. LPM
Tanggal Bukti
No Lembaga Tanda Tangan
Penyerahan Dokumen

Lembaga Penjamin Mutu:

https://docs.google.com/forms/d/e/1FAIpQ Screenshoot
1
LSfO1SqvvK0i- Bukti mengisi
2JX3zc5tSptv8PLPKLFgqoicFQc-b0BY- google form
LD5Q/viewform

Binjai, ............................................. 20
Hormat Saya,

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