Contoh Laporan Selesai Studi/Kuliah (Ijin Belajar)

                                                                                                                                                     LAMPIRAN I
                                                                                                                                                     SURAT EDARAN GUBERNUR JAWA TENGAH 
                                                                                                                                                     NOMOR      : ...............................
                                                                                                                                                     TANGGAL   : ...............................                                                                                                                                                      __________________________________

                                                                                                                                                     ………………………., …………………………
                                                                                                                                                     Kepada Yth.
                                                                                                                                                     BAPAK GUBERNUR JAWA TENGAH
                                                                                                                                                     melalui
                                                                                                                                                     KEPALA DINAS PERINDUSTRIAN
                                                                                                                                                     DAN PERDAGANGAN
                                                                                                                                                     PROPINSI JAWA TENGAH
                                                                                                                                                     di –
                                                                                                                                                     SEMARANG

Dengan hormat, kami yang bertanda tangan di bawah ini :

1. Nama / NIP.     : ..............................

2. Pangkat / Gol. : ..............................

3. Jabatan                : ..............................

4. Instansi               : ..............................

berdasarkan Surat Ijin Belajar tanggal ....... Nomor .........., melaporkan telah menyelesaikan studi/pendidikan pada (....Nama Perguruan Tinggi, Program Studi, Strata Pendidikan....), dengan baik.

Sebagai bahan laporan kami, berikut terlampir masing-masing sebanyak 1 (satu) lembar :

1. Foto kopi sah Surat Ijin Belajar;

2. Foto kopi sah Ijazah;

3. Foto kopi sah Transkrip Nilai;

Demikian untuk menjadikan periksa.

                                                                                                                                                                                                             Hormat Kami,

                                                                                                                                                                                                 ....Nama Terang (ybs).....
                                                                                                                                                                                                  ..Pangkat/Gol. Ruang...
                                                                                                                                                                                                  NIP. .........