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Nama Lengkap *
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NIM *
Nomor Induk Mahasiswa
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Fakultas/ Sekolah *
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Program Studi *
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Umur *
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Jenis Kelamin *
Asal Daerah *
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Punya pekerjaan selain kuliah atau sekolah? *
Jumlah Pendapatan Pribadi
Penghasilan selain pemberian orangtua
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Riwayat Sekolah Agama (Formal)
Misal : MI, Tsanawiyah, Aliyah, UIN, IAIN, STAI, Pondok Pesantren, LPIA, Dll. Jika tidak pernah kosongkan saja.
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