Customer Feedback Form Template – Quality Management Center

Nama* Name *^*

No Handphone* Mobile Phone Number *^*

Institusi* Institution *^*

Jabatan* Position *^*

Jenis Instansi* Types of Institution *^*

Perguruan Tinggi (University)

Lembaga Pendidikan (Educational Institution)

Sekolah (School)

Instansi Pemerintah (Goverment Institution)

Instansi Swasta (PrivateInstitution)

Industri/Stakeholder (Company/Stakeholder)

Rumah Sakit (Hospital)

Organisasi (Organisation)

Pers (Press)

Lainnya (Other)

Other:

Unit yang diajak Kerjasama (anda dapat memilih lebih dari 1)* Name of Partner Unit/Faculty (you can choose more than one) *^*