DATA MAHASISWA
Isilah dengan benar !
Nama
: .......................................................................
NIM
: .......................................................................
Nomor HP
: ........................................................................
Semester
: ........................................................................
Prodi Anda
: .......................................................................
Nama Sekolah SMU atau
SMK : .......................................................................
Alamat Sekolah
:.......................................................................
Kecamatan Khusus di
Maumere :.......................................................................
Kecamatan selain
Kabupaten Sikka :.......................................................................
Kabupaten/Provinsi lain
:.......................................................................