Formulir Pendaftaran BEASISWA PPA Polinela
Nama Mahasiswa *
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Jenis Kelamin *
NPM *
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Surat Keterangan Tidak Mampu *
Listrik *
Berapa kali ikut seminar (selama di Polinela) di buktikan dgn sertifikat *
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Jabatan di UKM *
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IPK *
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Nama Ayah *
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Nama Ibu *
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Pekerjaan Ayah *
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Pekerjaan Ibu *
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Penghasilan Orang Tua *
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Nilai Kedisiplinan *
Jumlah Tanggungan *
Semester *
Program Studi *
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No HP *
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No. REKENING *
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Nama BANK
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Nama di Rekening *
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