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Formulir Data Base Mahasiswa

Teknik Fisika ITS 2016


NRP :............................................................................................
Nama :............................................................................................

Data Pribadi
Nama Lengkap :............................................................................................
Nama Panggilan :............................................................................................
Tempat/Tanggal Lahir :............................................................................................
Agama :............................................................................................
Jenis Kelamin :............................................................................................
Golongan Darah :............................................................................................
Berat Badan :............................................................................................
Tinggi Badan :............................................................................................
Kelainan Mata :............................................................................................
Alamat Asal :............................................................................................
Alamat Surabaya :............................................................................................
No. HP :............................................................................................
E-mail :............................................................................................
Twitter :............................................................................................
Facebook :............................................................................................
Website/Blog Pribadi :............................................................................................
Anak ke :............................................................................................
Motto Hidup :............................................................................................
Riwayat Pendidikan : 1. TK Tahun Lulus
2. SD Tahun Lulus
3. SMP Tahun Lulus
4. SMA Tahun Lulus
Riwayat Organisasi

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