FORMULIR BEASISWA ALUMNI FEMA BERBAGI 2011

Nama Lengkap :
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NRP :
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TTL :
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Alamat Rumah :
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No Handphone :
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Alamat email :
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Nama Orangtua : Ayah :

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Ibu :
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Pekerjaan orangtua : Ayah :

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Ibu :
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Penghasilan orangtua : Rp.

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Pendidikan terakhir : Ayah :

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Ibu :
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Anak ke : __________ dari __________bersaudara.

N Nama Organisasi Jabatan

o
1

Organisasi kemahasiswaan :

Yang diikuti di kampus saat ini

Beasiswa Alumni FEMA Berbagi

 Indeks Prestasi Kumulatif :
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Rencana semester depan : Jumlah SKS yang akan diambil: ____ Perkiraan biaya yang
dibutuhkan: Rp_______________

Sumber dana kuliah saat ini : Orang Tua Diri Sendiri Beasiswa Lainnya,
sebutkan_______________

Pengeluaran Perbulan : Rp.

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N Prestasi T
o a
h
u
n

Prestasi di kampus :

Beasiswa yang pernah diterima: (sebutkan)

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Ceritakan kegiatan anda sehari-hari dikampus (max 50 kata):

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Alasan sehingga anda layak mendapat beasiswa ini (max 50 kata):

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Ceritakan impian anda ketika anda lulus kuliah nanti (max 70

kata):_________________________________________________

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Beasiswa Alumni FEMA Berbagi