Anda di halaman 1dari 2

DAFTAR RIWAYAT HIDUP

PESERTA WORKSHOP PENGISIAN LAPORAN EMIS PTKIS


SEMESTER GANJIL TAHUN 2022-2023
PADA PTKIS DI LINGKUNGAN KOPERTAIS WILAYAH II JAWA BARAT

A. Biodata Pribadi

1. Nama : .................................................................................
2. Tempat tanggal lahir : .................................................................................
3. NIDN/NIDK/NUP : .................................................................................
4. Pangkat / Gol. Ruang : .................................................................................
5. Jabatan Akademik : .................................................................................
6. Alamat Rumah : .................................................................................
7. Alamat Kantor : .................................................................................
8. No. HP : .................................................................................
9. Alamat Email : .................................................................................

B. Riwayat Pendidikan

1. Sarjana Muda : .................................................................................


2. Sarjana Lengkap (S.1) : .................................................................................
3. Magister : .................................................................................
4. Doktor : .................................................................................
5. Lain-lain : .................................................................................

C. Asal Peserta

1. Nama PTKIS : .................................................................................


2. Jabatan di PTKIS : .................................................................................

Bandung, ...................................

.............................................

Anda mungkin juga menyukai