FORM PENGAJUAN SURAT MAHASISWA                                                FORM PENGAJUAN SURAT MAHASISWA
         No. Agenda    : __________________                                            No. Agenda    : __________________
         Nama          : ________________________________________                      Nama          : ________________________________________
         NPM.          : __________________                                            NPM.          : __________________
         No. Telp.     : ________________________________________                      No. Telp.     : ________________________________________
                                  KEPERLUAN SURAT                                                               KEPERLUAN SURAT
                    PENGANTAR UNTUK : PENELITIAN SKRIPSI / KKL / INTERNSHIP                       PENGANTAR UNTUK : PENELITIAN SKRIPSI / KKL / INTERNSHIP
                               SURAT KETERANGAN MAHASISWA                                                    SURAT KETERANGAN MAHASISWA
                          TUGAS MATA KULIAH ......................................                      TUGAS MATA KULIAH ......................................
                                       KEPADA YTH.                                                                   KEPADA YTH.
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                             JUDUL : SKRIPSI / KKL / INTERNSHIP                                            JUDUL : SKRIPSI / KKL / INTERNSHIP
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                         DATA-DATA YANG DIBUTUHKAN / KEPERLUAN                                         DATA-DATA YANG DIBUTUHKAN / KEPERLUAN
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                      TANDA TANGAN  & NAMA TERANG DOSEN PEMBIMBING                                  TANDA TANGAN & NAMA TERANG DOSEN PEMBIMBING
                               YOGYAKARTA, .................................                                 YOGYAKARTA, .................................
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