8/18/2019 Permohonan Surat Pernyataan

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Kampus Ketintang, Jalan Ketintang,Surabaya 60231T : +6231-8280009,Pes. 400/410F : +6231-8281466

 

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FAKULTAS ILMU SOSIAL DAN HUKUM

 

PERMOHONAN SURAT PERNYATAAN MASIH KULIAH

 NAMA : ................................................................................................

 NIM : ................................................................................................

TTL : ................................................................................................

JURUSAN/PRODI : ................................................................................................

SEMESTER : (GASAL/GENAP)

TH.AKADEMIK : (…………………/…………………..)

 NAMA ORANG TUA : ................................................................................................

 NIP/NRP : ................................................................................................

PANGKAT/GOLONGAN : ................................................................................................

INSTANSI : ................................................................................................

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Surabaya, ………………………….PEMOHON,

………………………………………

 NIM………………………………….

** u!"#a$ a$%a$ &a'a" uru 'a&"a!KELENGKAPAN :

. + KK - LEMAR 

2.   + KTM - LEMAR