FORMULIR CALON PENERIMA

BEASISWA PENINGKATAN PRESTASI AKADEMIK ( BPPA )

UNIVERSITAS JENDERAL ACHMAD YANI
TAHUN 2018
BIODATA PRIBADI
Nama :..................................................................................................................
NIM :..................................................................................................................
Jenis Kelamin :..................................................................................................................
Fakultas / Jurusan :..................................................................................................................
Program :S1/D3
IP ( Terbaru ) :..................................................................................................................
IPK ( Terbaru ) :..................................................................................................................
Tahun Masuk :..................................................................................................................
Semester :..................................................................................................................
Alamat :..................................................................................................................
...................................................................................................................
Telp/HP :..................................................................................................................
BIOTADA ORANG TUA
Nama Ayah :..................................................................................................................
Pekerjaan :..................................................................................................................
Penghasilan perbulan :..................................................................................................................
Alamat :..................................................................................................................
...................................................................................................................
Telp/Hp :..................................................................................................................
Nama Ibu :..................................................................................................................
Pekerjaan :..................................................................................................................
Alamat :..................................................................................................................
...................................................................................................................

Cimahi,
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