Contoh Formulir Pendaftaran Munaqasah - Dunia Makalah

CONTOH FORMULIR PENDAFTARAN MUNAQASAH

Pas foto   3 x 4

1.  Nomor Induk Mahasiswa        :   ..............................................................................

2.    Nama (sesuai ijazah)               :   ..............................................................................

3.    Tempat Lahir (sesuai ijazah)  :   ..............................................................................

4.    Tanggal Lahir (sesuai ijazah) :   ..............................................................................

5.    Jenis Kelamin                            :   Laki-laki / Perempuan

6.    Alamat Asal                                :   Jln.........................................................................

Desa ...................................................................  

Kecamatan ........................................................  

Kabupaten .........................................................

7.    Asal Sekolah/Madrasah          :   .............................................................................................................

8.    Tahun Masuk UIN Mataram    :   .............................................................................................................

9.    No. HP.                                       :   .............................................................................................................  

10. Email                                           :   .............................................................................................................

11. Pembimbing  I                            :   .............................................................................................................
Pembimbing  II                           :   .............................................................................................................

12. Jurusan                                      :   .............................................................................................................

13. Judul Skripsi                              :                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        

 

Persyaratan Pendaftaran Munaqasah:

a)    Menyerahkan Kwitansi SPP/UKT Asli 4 (empat) semester terakhir;

b)    Transkrip Nilai Sementara;

c)    Skripsi 4 (Empat) eksemplar;

d)    Foto copy Ijazah terakhir 2 (dua) lembar;

e)    Foto copy Akte Kelahiran 2 (dua) lembar;

f)     Surat keterangan bebas pinjam Perpustakaan Daerah Prov. NTB.;

g)    Surat keterangan bebas pinjam Perpustakaan UIN Mataram;

h)    Pas Foto hitam putih full dress 3x4 sebanyak 10 lembar

Ketentuan: Foto mengenakan Almamater UIN Mataram, baju kemeja putih, berdasi bagi laki-laki dan jilbab putih bagi perempuan, Logo UIN Mataram terlihat penuh, dan dicetak menggunakan kertas doff.

Mataram, ...... .................................. 201...

Mahasiswa Ybs.,

 

 

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NIM.