BLANGKO BIODATA MAHASISWA

PUSAT PENELITIAN DAN PENGABDIAN
MASYARAKAT (P3M)

BLANGKO BIODATA MAHASISWA
PESERTA KULIAH KERJA NYATA
KKN-P2EM STIE PEMBANGUNAN TANJUNGPINANG

Nama

: ....................................................................................................

Nim / Nirm

: ....................................................................................................

Prodi

: ....................................................................................................

Kelas

: ....................................................................................................

Alamat

: ....................................................................................................
: ....................................................................................................

Telp/Hp

: ....................................................................................................

Nama Orang Tua

: ....................................................................................................

Alamat Orang Tua : ....................................................................................................
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Tanjungpinang,.............................................
PAS

PHOTO
3X4
(WARNA)

(.................................................)
Nirm.

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