Medan, ..........................................

Hal : Permohonan
Kepada Yth.
Direktur Pascasarjana UIN-SU
di-
Medan

Assalamu`alaikum Wr. Wb.

Dengan hormat, saya yang bertanda tangan di bawah ini:
Nama : ...........................................................................................................
NIM : ...........................................................................................................
TTL : ...........................................................................................................
Semester : ...........................................................................................................
Program Studi : ...................................................Reguler/Non Reguler/BS/S2/S3
Pekerjaan : ...........................................................................................................
Alamat Kantor : ...........................................................................................................
...........................................................................................................
Alamat Rumah : ...........................................................................................................
...........................................................................................................
Jarak : ..................... Km (Rumah ke Pascasarjana)
Nomor HP : ...........................................................................................................
Judul Tesis/Disertasi:
.........................................................................................................................................
.........................................................................................................................................
.........................................................................................................................................
.........................................................................................................................................
memohon kepada Bapak untuk sudi kiranya memberikan kepada saya :
1. .............................................................................................................................
2. .............................................................................................................................
3. .............................................................................................................................
4. .............................................................................................................................
yang akan saya pergunakan untuk melengkapi persyaratan untuk:
.........................................................................................................................................
Sebagai bahan pertimbangan saya lampirkan fotokopi bukti setoran SPP dari awal
sampai dengan terakhir.
Demikian surat permohonan ini saya sampaikan. Atas perhatian Bapak, saya
ucapkan terimakasih.
Wassalam,
Pemohon,

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