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Pendaftaran Mahasiswa Baru 2020
(Mohon mengisi Data di bawah ini dengan benar)
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NAMA LENGKAP
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(Sesuai dengan Ijazah/SKHU)
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JENIS KELAMIN
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Laki-Laki
Perempuan
TEMPAT LAHIR
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TANGGAL LAHIR
MM
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DD
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YYYY
NOMOR HP YANG AKTIF
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ALAMAT LENGKAP
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NAMA AYAH
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NAMA IBU
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E-MAIL
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ASAL SEKOLAH (SMA/SMK/MA)
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TAHUN TAMAT SEKOLAH (SMA/SMK/MA)
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PROGRAM STUDI YANG DIPILIH
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Teknik Mesin
Teknik Sipil
Teknik Industri
Teknik Elektro
AGAMA
Islam
Kristen
Katholik
Budha
Hindu
Other:
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