IDENTITAS PROGRAM STUDI
Program Studi (PS) : ......................................................................
Jurusan/Departemen : ......................................................................
Fakultas : .......................................................................
Perguruan Tinggi : .......................................................................
Nomor SK pendirian PS (*) : .......................................................................
Tanggal SK pendirian PS : .......................................................................
Pejabat Penandatangan
SK Pendirian PS : .......................................................................
Bulan & Tahun Dimulainya
Penyelenggaraan PS : .......................................................................
Nomor SK Izin Operasional (*) : ..................................................................
Tanggal SK Izin Operasional : .......................................................................
Peringkat (Nilai) Akreditasi Terakhir: ................................................................
Nomor SK BAN-PT : ........................................................................
Alamat PS : .......................................................................
No. Telepon PS : .......................................................................
No. Faksimili PS : .......................................................................
Homepage dan E-mail PS : .......................................................................
(*) : Lampirkan fotokopi SK terakhir