Form1PengajuanRencanaPKL-24082015
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Pengajuan Rencana Praktek Kerja Lapang (PKL) Semester : Ganjil / Genap Tahun Akademik : .......................................... NIM : .................................. Nama MHS : .................................................. No HP :............................................... (Yang Bisa Dihubungi) IP Kumulatif : ................................ SKS Kumulatif : ............................................ Judul : ...................................................... .................................................... ....................................................................... ................................................................... ....................................................................... ................................................................... Nama Instansi PKL : ...................................................... ................................................. Alamat Instansi : ...................................................... ...................................................... Kec ................................ Kota ......................................Propinsi : ................. ................... KEMENTERIAN RISET, TEKNOLOGI DAN PENDIDIKAN TINGGI UNIVERSITAS BRAWIJAYA PROGRAM KEDOKTERAN HEWAN PROGRAM STUDI : S-1 PENDIDIKAN DOKTER HEWAN Jl. M.T. Haryono 169 Malang 65145 Telp/Fax. 0341-573642 Email : Form-1
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Transcript of Form1PengajuanRencanaPKL-24082015
Pengajuan Rencana Praktek Kerja Lapang (PKL)
Semester : Ganjil / Genap Tahun Akademik : ..........................................
NIM : .................................. Nama MHS : ..................................................
No HP :............................................... (Yang Bisa Dihubungi)
IP Kumulatif : ................................ SKS Kumulatif : ............................................
Judul : ..........................................................................................................
..........................................................................................................................................
..........................................................................................................................................
Nama Instansi PKL : .......................................................................................................
Alamat Instansi : ............................................................................................................
Kec ................................ Kota ......................................Propinsi : ....................................
Tanggal Pelaksanaan : .....................................................................................................
Calon Pembimbing
Pembimbing 1 : .....................................................................
NIP : ......................................................................
Pembimbing 2 : .....................................................................
NIP : ......................................................................
Pembimbing hanya isi oleh Wakil Bidang Akademik
Malang, ....................................Wakil Bidang Akademik
Prof.Dr.Aulanni'am,drh.,DESNIP. 19600903 198802 2 001
Yang Mengajukan,
............................................................
NIM....................................................
Persyaratan : KRS & KHS Terbaru Dan Stofmap Folio Warna Hijau(2010) Stofmap Folio Warna Merah (2012) Surat Pengantar Dari Kasubag Akademik-PKH-UB. Proposal. Mahasiswa diwajibkan mengisi data pengajuan di http://pkh.ub.ac.id/akademik/pendidikan-
dokter-hewan/ pada menu ( Form Pengajuan Rencana PKL Online )sebelum di serahkan ke ibu fitri
KEMENTERIAN RISET, TEKNOLOGI DAN PENDIDIKAN TINGGIUNIVERSITAS BRAWIJAYAPROGRAM KEDOKTERAN HEWANPROGRAM STUDI : S-1 PENDIDIKAN DOKTER HEWANJl. M.T. Haryono 169 Malang 65145 Telp/Fax. 0341-573642 Email : [email protected]
Form-1
