Nama : .................................................................................................................. NIM/NIK/NIP : .................................................................................................................. Jabatan : .................................................................................................................. No. HP : .................................................................................................................. Alamat : .................................................................................................................. .................................................................................................................. Hubungan dengan yang direkomendasi : ................................................................................... Menyatakan bahwa : Nama : .................................................................................................................. NIM/Prodi : .................................................................................................................. No. HP : .................................................................................................................. Alamat : .................................................................................................................. .................................................................................................................. Menurut saya baik/sangat baik untuk direkomendasikan mengikuti seleksi mentor/mentee berprestasi dalam Program Pendampingan Agama Islam (Mentoring) yang diselenggarakan oleh Lembaga Pengkajian dan Pengamalan Islam (LPPI) Universitas Muhammadiyah Purwokerto. Alasan saya : .................................................................................................................................................... .................................................................................................................................................... .................................................................................................................................................... .................................................................................................................................................... .................................................................................................................................................... .................................................................................................................................................... .................................................................................................................................................... ....................................................................................................................................................
Demikian rekomendasi saya, semoga bermanfaat.
Purwokerto, ................................ 2018 Hormat saya,