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ANGKATAN :

BIODATA MAHASISWA
PRODI TEKNIK INFORMATIKA FOTO

DATA PRIBADI :

NAMA : ..............................................................................................
NPM : ..............................................................................................
PEMBIMBING AKADEMIK : ..............................................................................................
TEMPAT/TGL LAHIR : ..............................................................................................
JENIS KELAMIN : ..............................................................................................
AGAMA : ..............................................................................................
ALAMAT : ..............................................................................................
..............................................................................................
KODE POS : ................... PHONE : ...................................
ASAL SEKOLAH : ..............................................................................................

DATA ORANG TUA

NAMA : ..............................................................................................
PEKERJAAN : ..............................................................................................
ALAMAT : ..............................................................................................
..............................................................................................
KODE POS : ................... PHONE : ...................................

. 4.FM-D2.14.01 Rev 00 Tgl. Berlaku 01 September 2019

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