Form Biodata Registrasi Ulang SPMB

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  • 7/26/2019 Form Biodata Registrasi Ulang SPMB

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    KEMENTERIAN RISET, TEKNOLOGI, DAN PENDIDIKAN TINGGI

    UNIVERSITAS SULTAN AGENG TIRTAYASA

    PPAASSCCAASSAARRJJAANNAAJl. Raya Jakarta Km. 04 Pakupatan Serang

    Telepon : (0254) 280330, Ext 204 Fax. (0254) 281254

    BIODATA MAHASISWA BARU PASCASARJANA

    FORM REGISTRASI

    Petunjuk : Isilah data dengan lengkap dan benar

    .............................................................................................

    No. HP / Email : ............................................/................................................

    Pendidikan Terakhir : Gelar Akademik : ...............................................................

    IPK : ...............................................................

    Program Studi : ...............................................................

    Tahun Lulus : ...............................................................

    Universitas : ...............................................................

    Pekerjaan : .............................................................................................

    Instansi Tempat Bekerja : .............................................................................................

    Jabatan : .............................................................................................

    Golongan Darah : .............................................................................................

    Nama Ibu Kandung : .............................................................................................

    Nama Ayah Kandung : .............................................................................................

    Serang, ................................

    Mahasiswa,

    (..........................................)

    Pas foto

    3 x 4berwarna

    Nama Lengkap : .............................................................................................

    No. Test : .............................................................................................

    Program Studi Pilihan : ....................................Konsentrasi........................................

    Tempat, Tanggal Lahir : ......................................./....................................................

    Jenis Kelamin / Agama : ......................................./....................................................

    Alamat Rumah (Lengkap) : .............................................................................................

    .............................................................................................