BIDIKMISI

POLITEKNIK NEGERI PADANG

Kampus Limau Manis – Padang
Telepn (0751) 72590, Faks (72576)

FORMULIR PENDAFTARAN
BEASISWA BIDIKMISI FOUNDATION (BMF)

A. DATA MAHASISWA

Nama : ...............................................................
No Bp : ...............................................................
Photo
Jurusan : ...............................................................
3x4
Prodi : ...............................................................
Tempat/tgl lahir : ...............................................................
Jenis Kelamin : ...............................................................
No. Tlp/HP : ......................................................................................................
Alamat Asal : ......................................................................................................
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Alamat Sekarang : ......................................................................................................
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B. DATA ORANG TUA

1. NAMA ORANGTUA
- Ayah : ......................................................................................................
- Ibu : ......................................................................................................
2. PEKERJAAN ORANG TUA
- Ayah : ......................................................................................................
- Ibu : ......................................................................................................

C. DATA WALI

1. Nama : ......................................................................................................
2. Pekerjaan : ......................................................................................................

Motivasi Mendaftar Beasiswa BMF :

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