SEKOLAH TINGGI ILMU EKONOMI (STIE)

BUDI PERTIWI
Akreditasi BAN-PT No : 6033/SK/BAN-PT/Ak-PPJ/S/VI/2021 Ketua PMB
Jl. Lingkar Tanjungpura Bendasari, Kondangjaya Karawang Timur – Karawang. www.stiebudipertiwi.ac.id

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FORMULIR PENDAFTARAN Referensi

No Pendaftaran : ...........
Nama : ...........................................................................................................
NIK : ...........................................................................................................
Tempat / Tgl Lahir : ...........................................................................................................
Jenis Kelamin : ...........................................................................................................
Agama : ...........................................................................................................
Alamat : ...........................................................................................................
RT/RW : ...../..... Desa/Kel : ..........................................................
Kecamatan : .................................................................................
Kabupaten : ...................................................................................
Alamat E-Mail : .....................................................................................................
No Tlp / Hp : ...........................................................................................................
No Tlp Kantor : ...........................................................................................................
Status Perkawinan : ...........................................................................................................
Pekerjaan : ...........................................................................................................
Asal Sekolah : ...........................................................................................................
Jurusan ................................... Tahun Lulus ....................................
Nama Ibu Kandung : ...........................................................................................................
Alamat : ...........................................................................................................
...........................................................................................................
No Tlp / Hp : ...........................................................................................................
Program Studi : Ekonomi Pembangunan (S1)
Pilihan Kelas : Pagi Sore
Sumber Informasi : Brosur / Spanduk Kunjungan Kelas
Informasi guru / teman Lain-lain ..............................
Biaya Kuliah : Ditanggung orangtua Ditanggung sendiri
Program beasiswa Lain-lain ..............................

Data yang saya berikan dalam formulir pendaftaran ini adalah yang sebenar-benarnya.

Karawang, ..........................., 20....

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