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BIODATA MAHASISWA BIDIKMISI

UNIVERSITAS TADULAKO
ANGKATAN 2016
Data Pribadi
Nama Lengkap :...............................................................................................................
Tempat/Tanggal Lahir :...............................................................................................................
Alamat :...............................................................................................................
Agama :...............................................................................................................
Asal Sekolah :...............................................................................................................
Fakultas/Jurusan/Prodi :...............................................................................................................
No. Hp :...............................................................................................................
E-Mail :...............................................................................................................
Sosial Media :...............................................................................................................

Data Orang Tua/Wali


1. Nama
a. Ayah :...............................................................................................................
b. Ibu :...............................................................................................................
2. Pekerjaan
a. Ayah :...............................................................................................................
b. Ibu :...............................................................................................................
Pengalaman Organisasi
...........................................................................................................
...........................................................................................................

FOTO

3X4

Palu, 2017
Mengetahui,

Orang Tua/Wali, Mahasiswa,

(………………………..) (………………………..)
Stambuk :

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