Form Data Mahasiswa

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Form Data Mahasiswa

* Indicates required question

Nama Lengkap: *

Your answer

Jenis Kelamin *

Laki-laki

Perempuan

Tanggal Lahir *

MM

/

DD

/

YYYY

Tempat lahir *

Your answer

Nama Ibu *

Your answer

Agama *

Choose

Islam

Kristen

Katolik

Hindu

Budha

Khonghucu

Kewarganegaraan *

Choose

WNI

WNA

NIK *

Your answer

NISN

Your answer

Alamat Lengkap *

Your answer

Penerima KPS (Kartu Perlindungan Sosial) *

Ya

Tidak

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