NAMA :...................................................................................
NPM :...................................................................................
TEMPAT TGL LAHIR :...................................................................................
KELAS MI (I/II/III) :...................................................................................
SEMESTER :...................................................................................
AGAMA :...................................................................................
JENIS KELAMIN :...................................................................................
ALAMAT :...................................................................................
MOTTO HIDUP :...................................................................................
NO.TELP/HP :...................................................................................
E-MAIL/FB/IG :...................................................................................
RIWAYAT PENDIDIKAN
SD/MI :...................................................................................
SMP/MTS :...................................................................................
SMA/SMK/MA :...................................................................................
ORGANISASI YANG PERNAH DIIKUTI SELAMA SMA/SMK/MA
1. ........................................................................................................................
2. ........................................................................................................................
3. ........................................................................................................................
4. ........................................................................................................................
BUKITTINGGI.....,...............,..........
...............................................
CP : 089617580463 (BOBI)
082287317115 (YOLA)