BIODATA MAHASISWA

1. NAMA : ..................................................................................
NIM : ..................................................................................
ALAMAT DI PALANGKA RAYA : ..................................................................................
: ..................................................................................
: ..................................................................................
JENIS KELAMIN : ..................................................................................
NO.TELPON/HP : ..................................................................................
PROGRAM STUDI : ..................................................................................
TEMPAT TANGGAL LAHIR : ..................................................................................
AGAMA : ..................................................................................
2. NAMA BAPAK : ..................................................................................
TTL BAPAK : ..................................................................................
PEKERJAAN BAPAK : ..................................................................................
3. NAMA IBU : ..................................................................................
TTL IBU : ..................................................................................
PEKER JAAN IBU : ..................................................................................
4. ALAMAT ORANGTUA/WALI : ..................................................................................
: ..................................................................................
: ..................................................................................
NOMOR TELPON ORTU/WALI : ..................................................................................
5. UKT/BIDIK MISI : ..................................................................................

Hasil Studi
Semester 1 2 3 4 5 6 7 8 9 10 11 12 13 14
ƩSKS
Lls
IP Smt
IPK

Palangkaraya, 2021

Syarat Registrasi/Lampiran:
1. Fotocopy Kwitansi SPP/UKT …………………………………
2. Fotocopy Bukti Heregristrasi Fakultas Nim :
3. Fotocopy Kartu Mahasiswa
4. Fotocopy Bukti Regis HMJ BDP

• MOHON DATA DIISI DENGAN LENGKAP DAN JELAS