DATA DIRI CALON MAHASISWA DIII KERJASAMA (1)
DATA DIRI CALON MAHASISWA
DIII KERJASAMA FTUNDIP – PT PLN (PERSERO)
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
No. Test
:............................................................................................................
NAMA
:............................................................................................................
TEMPAT/TGL LAHIR :............................................................................................................
JENIS KELAMIN
:L/P
NAMA ORANG TUA
:............................................................................................................
ALAMAT
:............................................................................................................
.............................................................................................................
HUB. KELUARGA
: (Anak Kandung, Anak Angkat, Wali)
ASAL SEKOLAH
:............................................................................................................
JURUSAN
: (MA /SMU / SMK)
No. Telp. (HP)
:............................................................................................................
Calon Mahasiswa
(.................................................)
DIII KERJASAMA FTUNDIP – PT PLN (PERSERO)
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
No. Test
:............................................................................................................
NAMA
:............................................................................................................
TEMPAT/TGL LAHIR :............................................................................................................
JENIS KELAMIN
:L/P
NAMA ORANG TUA
:............................................................................................................
ALAMAT
:............................................................................................................
.............................................................................................................
HUB. KELUARGA
: (Anak Kandung, Anak Angkat, Wali)
ASAL SEKOLAH
:............................................................................................................
JURUSAN
: (MA /SMU / SMK)
No. Telp. (HP)
:............................................................................................................
Calon Mahasiswa
(.................................................)