FORMULIR PENGAJUAN JUDUL KARYA TULIS ILMIAH

F.STKH.UP3M.15
R.00.T.25.01.17

1. Nama Mahasiswa : ......................................................................................................

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

Prodi/Semester : ......................................................................................................

2. No. Tlp/Hp : .....................................................................................................

Dengan ini mengajukan judul penelitian :

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3. Pembimbing I : ......................................................................................................

4. Pembimbing II : .....................................................................................................

Dosen Pembimbing I Dosen Pembimbing II Mahasiswa

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Mengetahui,
Ka. UP3M

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