KEMENTERIAN RISET, TEKNOLOGI DAN PENDIDIKAN TINGGIUNIVERSITAS BRAWIJAYA

FAKULTAS PERIKANAN DAN ILMU KELAUTAN Jalan Veteran Malang – 65145, Indonesia

Telp. +62-0341-553512, Fax. +62-0341-557837E-mail : faperik@ub.ac.id http://www.fpik.ub.ac.id

PENGAJUAN SURAT PENGANTARNama : ......................................................................................................................................

N I M : ......................................................................................................................................

Program Studi : .....................................................................................................................................

Jenis Surat : Pengantar PKL / PKM / Skripsi

Kredit Kumulatif : ......................................................................................................................................

I. P Kumulatif : ......................................................................................................................................

Nilai : KKN : PKL : Seminar :

Catatan :

I. Mempunyai Nilai D dalam Mata Kuliah :

1. .........................................................................................................................................................

2. .........................................................................................................................................................

3. .........................................................................................................................................................

II. Mempunyai Nilai E dalam Mata Kuliah :

1. .........................................................................................................................................................

2. .........................................................................................................................................................

3. .........................................................................................................................................................

III. Mengulang Mata Kuliah Semester sekarang

1. ...........................................................................................................................................................

2. ...........................................................................................................................................................

3. ..........................................................................................................................................................

IV. Melampirkan KHS dan KRS asli semester terakhir.

V. Melampirkan foto copy nilai PKL / PKM, bagi yang mengajukan surat keterangan skripsi.

Malang, ......................................Yang Mengajukan,

___________________________NIM.