Biodata Mahasiswa Baru Kmk 2015

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BIODATA MAHASISWA KMK FEB UNIVERSITAS BRAWIJAYA 1. NAMA LENGKAP : ______________________________________________________ 2. NAMA PANGGILAN : ______________________________________________________ 3. NAMA BAPTIS : ______________________________________________________ 4. NAMA KRISMA : ______________________________________________________ 5. FAKULTAS/PROGRAM STUDI : __________________________/___________________________ 6. JENIS KELAMIN : ______________________________________________________ 7. TEMPAT DAN TANGGAL LAHIR : ______________________________________________________ 8. AGAMA : ______________________________________________________ 9. KEWARGANEGARAAN : ______________________________________________________ 10. GOLONGAN DARAH : ______________________________________________________ 11. ALAMAT DIMALANG : ______________________________________________________ _______________________ Tlp. : __________________________ 12. EMAIL : ______________________________________________________ 13. ID LINE : ______________________________________________________ 14. JUMLAH SAUDARA KANDUNG : KAKAK : ______________________________________________________ ADIK : ______________________________________________________ 15. KEGEMARAN / HOBBY : 1. ____________________________________________________ Tempel pas foto 3X4

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Transcript of Biodata Mahasiswa Baru Kmk 2015

Page 1: Biodata Mahasiswa Baru Kmk 2015

BIODATA MAHASISWA KMK FEB UNIVERSITAS BRAWIJAYA

1. NAMA LENGKAP : ______________________________________________________

2. NAMA PANGGILAN : ______________________________________________________

3. NAMA BAPTIS : ______________________________________________________

4. NAMA KRISMA : ______________________________________________________

5. FAKULTAS/PROGRAM STUDI : __________________________/___________________________

6. JENIS KELAMIN : ______________________________________________________

7. TEMPAT DAN TANGGAL LAHIR : ______________________________________________________

8. AGAMA : ______________________________________________________

9. KEWARGANEGARAAN : ______________________________________________________

10. GOLONGAN DARAH : ______________________________________________________

11. ALAMAT DIMALANG : ______________________________________________________

_______________________ Tlp. : __________________________

12. EMAIL : ______________________________________________________

13. ID LINE : ______________________________________________________

14. JUMLAH SAUDARA KANDUNG :

KAKAK : ______________________________________________________

ADIK : ______________________________________________________

15. KEGEMARAN / HOBBY : 1. ____________________________________________________

2. ____________________________________________________

3. ____________________________________________________

16. PRESTASI : 1. ____________________________________________________

2. ____________________________________________________

3. ____________________________________________________

17. ORANG TUA

NAMA AYAH : ______________________________________________________

PENDIDIKAN TERAKHIR : ______________________________________________________

PEKERJAAN : ______________________________________________________

ALAMAT : ______________________________________________________

_______________________ Tlp. : __________________________

NAMA IBU : ______________________________________________________

PENDIDIKAN TERAKHIR : ______________________________________________________

PEKERJAAN : ______________________________________________________

ALAMAT : ______________________________________________________

_______________________ Tlp. : __________________________

Tanda tangan Mahasiswa

_____________________

Tempel pas foto

3X4

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