Log Book

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LOG BOOK

<<NAMA TRACK>>

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

Alamat Tempat
Enrichment Program : …………………………………………..

Program Studi <<Nama Program Studi>>


Fakultas <<Nama Fakultas>>
Universitas Bina Nusantara
Data Pribadi Mahasiswa

Nim : ___________________________________________________

Nama Mahasiswa : ___________________________________________________

Alamat : ___________________________________________________

___________________________________________________

No. Telepon Rumah : ___________________________________________________

No. Telepon Kantor : ___________________________________________________

No. Ponsel : ___________________________________________________

Judul : ___________________________________________________

___________________________________________________

___________________________________________________

Mahasiswa,

Foto Mahasiswa
(ukuran 3x4cm)

__________________________________
CATATAN MAHASISWA
ACTIVITY RECORD <<NAMA TRACK>>
Site
Date Clock In Clock Out
No. Activity Description Supervisor
(DD/MM/YY) (HH:MM) (HH:MM)
Signature

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Site
Date Clock In Clock Out
No. Activity Description Supervisor
(DD/MM/YY) (HH:MM) (HH:MM)
Signature

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20.
Site
Date Clock In Clock Out
No. Activity Description Supervisor
(DD/MM/YY) (HH:MM) (HH:MM)
Signature

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Site
Date Clock In Clock Out
No. Activity Description Supervisor
(DD/MM/YY) (HH:MM) (HH:MM)
Signature

31.

Mengetahui,

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


<<Kode Dosen>>
<<Tanggal Persetujuan>>

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