AKADEMI KEPERAWATAN ANTARIKSA JAKARTA

Terakreditasi B
Depkes No. HL. 00.03.2.00235
Izin Menkes RI : No. HK 00.06.1.3.6166 Tahun 1988

FORMULIR PENDAFTARAN

Nama Instansi : AKADEMI KEPERAWATAN ANTARIKSA

Jurusan : D III KEPERAWATAN

No. Pendaftaran : AK-ANT..................................................................

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

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

Kewarga Negaraan : ................................................................................................

Jenis Kelamin : ................................................................................................

Agama : ................................................................................................

Berat Badan : ................................................................................................

Tinggi Badan : ................................................................................................

Alamat Lengkap : ................................................................................................

No. Telp/HP : ................................................................................................

Asal Sekolah : ................................................................................................

E-Mail (wajib diisi) : ................................................................................................

SYARAT PENDAFTARAN

1. Mengisi formulir pendaftaran*

2. Foto copy ijazah SMU/SMA/MA/SPK dan sederajat*
3. Pas photo berwarna ukuran 3x4 dan 4x6 masing-masing 10 lembar*
4. Tinggi badan minimal laki-laki 155 cm, perempuan 150 cm
5. Tidak buta warna
6. Kirim via e-mail : akperantariksa@telkom.net.id atau info_akperantariksa@yahoo.co.id

Ket :

*diserahkan pada saat registrasi di kampus

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