FORMULIR PENDAFTARAN MAHASISWA BARU
SEKOLAH TINGGI ILMU SYARIAH NAHDLATUL ULAMA
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NAMA PANGGILAN *
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NAMA (sesuai ijazah SMA/MA/SMK/Paket C) *
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JENIS KELAMIN *
TEMPAT LAHIR *
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TANGGAL LAHIR *
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ALAMAT *
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DESA/KELURAHAN *
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KECAMATAN *
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KABUPATEN/KOTA *
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PROVINSI *
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KODE POS *
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NO. HANDPHONE 1 *
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NO. HANDPHONE 2 *
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NAMA AYAH *
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NAMA IBU *
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ALAMAT ORANGTUA (Jika sama, Tulis sda) *
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ASAL SEKOLAH *
NAMA SEKOLAH *
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ALAMAT SEKOLAH *
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NOMOR IJASAH *
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TAHUN IJASAH *
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PRORGAM STUDI PILIHAN *
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