LOG BOOK

<<NAMA TRACK>>

Nama Tempat
:
Enrichment Program ………………………………………………..

Alamat Tempat …………………………………………………

:
Enrichment Program

<<Nama Program>>
<<Nama Program Studi >>
<<Nama Fakultas/ School>>
Universitas Bina Nusantara
 Data Pribadi Mahasiswa

Nim : ________________________________________

Nama Mahasiswa : ________________________________________

Alamat : ________________________________________

________________________________________

No. Telepon Rumah : ________________________________________

No. Telepon Kantor : ________________________________________

No. Ponsel : ________________________________________

Judul : ________________________________________

________________________________________

________________________________________

Mahasiswa,

Foto
Mahasiswa
(ukuran 3x4)

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CATATAN MAHASISWA
 ACTIVITY RECORD <<NAMA TRACK>>
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Mengetahui,

<<Nama Dosen Pembimbing Universitas (Faculty Supervisor)>>

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