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PANITIA UJI KOMPETENSI (UKOM)

PROGRAM STUDI D-III KEBIDANAN


UNIVERSITAS COKROAMINOTO MAKASSAR

DATA PESERTA

Nama Mahasiswa : ............................................................................................................

NIM : ............................................................................................................

Tempat/Tgl Lahir : ............................................................................................................

Alamat KTP : ............................................................................................................

Nama Jalan : ............................................................................................................

Desa / Kelurahan : ............................................................................................................

Kecamatan : ............................................................................................................

Kota / Kabupaten : ............................................................................................................

Provinsi : ............................................................................................................

E-Mail : ............................................................................................................

Hp Number : ............................................................................................................

IPK : ..................................................................................................... ......

Reteker Ke - : ............................................................................................................

Kota Tempat Ujian Kompetensi :

Provinsi Tempat Ujian :

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