PRA REGISTRASI
Formulir Pra Registrasi Mahasiswa Baru T.A. 2018
Nomor Peserta *
Your answer
NIK *
(Nomor Induk Kependudukan)
Your answer
Nama Lengkap *
(Sesuai Ijazah)
Your answer
Fakultas *
Program Studi *
Besaran UKT *
(Jika Anda Calon Penerima Bidikmisi, Tuliskan "Bidikmisi")
Your answer
Tempat Lahir *
Your answer
Tanggal Lahir *
MM
/
DD
/
YYYY
Jenis Kelamin
Agama *
Golongan Darah *
Kewarganegaraan *
Your answer
Alamat Tetap *
Your answer
Provinsi *
(Alamat Tetap)
Your answer
Kabupaten/Kota *
(Alamat Tetap)
Your answer
Alamat Selama Kuliah *
Your answer
Nomor Telpon / Handphone *
Your answer
Nama Ayah / Wali *
Your answer
Nama Ibu *
Your answer
Alamat Orang Tua *
Your answer
Provinsi *
(Alamat Orang Tua)
Your answer
Kabupaten / Kota *
(Alamat Orang Tua)
Your answer
Nomor Telpon / Handphone *
(Nomor Telpon / Handphone Orang Tua)
Your answer
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Additional Terms