DATA PRIBADI
Nama :________________________________
Tempat, Tanggal, & Lahir :________________________________
FOTO 3 x 4
Jenis Kelamin :________________________________
Agama :________________________________
NIM :________________________________
Program Study :________________________________
No. Telp :________________________________
E-Mail :________________________________
Alamat : ________________________________
________________________________
RIWAYAT PENDIDIKAN
1. Sekolah Dasar :
2. SMP :
3. SMA/ :
KEGEMARAN / HOBI
1. ______________________________________________________________________
2. ______________________________________________________________________
3. ______________________________________________________________________
4. ______________________________________________________________________
5. ______________________________________________________________________
KEAHLIAN
1. ______________________________________________________________________
2. ______________________________________________________________________
3. ______________________________________________________________________
4. ______________________________________________________________________
5. ______________________________________________________________________