Form Data Mahasiswa
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Nama Lengkap: *
Jenis Kelamin *
Tanggal Lahir *
MM
/
DD
/
YYYY
Tempat lahir *
Nama Ibu *
Agama *
Kewarganegaraan *
NIK *
NISN *
Alamat Lengkap *
Penerima KPS (Kartu Perlindungan Sosial) *
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