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KEMENTERIAN RISET, TEKNOLOGI DAN PENDIDIKAN TINGGI

UNIVERSITAS BRAWIJAYA
PROGRAM KEDOKTERAN HEWAN
Jalan Mayjen Haryono No : 169 Malang 65145
Telp. +62341- 573642, Fax. +62341- 573642, 551611 psw 362
http://www.pkh.ub.ac.id email : pkh_ub@ub.ac.id

Form Pendaftaran Ujian PKL

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Nama MHS : ..............................................................

Judul : ............................................................................................................

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Instansi PKL :...........................................................................................................

Yang Akan Diselengggarakan Pada:

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Penguji :
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Mengetahui
Malang, .....................................
WakilBidangAkademik

Drh. Dyah Ayu Oktavianie AP.,MBiotech


NIP. 198410262008122004