JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
BIMITS (Bidik Misi ITS)
Database Bidik Misi ITS
Dimohon di isi yang lengkap dan update, data ini akan digunakan untuk pendataan Dikti dan BIMITS
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Angkatan Bidik Misi
*
Contoh : 2012
Your answer
Nama Lengkap
*
Contoh : Budi Hermawan
Your answer
Nama Panggilan
*
Contoh : Budi
Your answer
Jenis Kelamin
*
Laki-laki
Perempuan
NRP
*
Contoh : 1112100100
Your answer
Jurusan
*
Jurusan Anda
Your answer
Tempat, Tanggal dan Lahir
*
Contoh : Surabaya, 10 Nopember 1945
Your answer
Alamat Asal
*
Format : Jalan, No Rumah, RT, RW, Desa/Kelurahan, Kota/Kabupaten, Kode Pos. Contoh : Jalan Nias 42 RT 21 RW 02, Keputih, Surabaya, 60118
Your answer
Alamat Surabaya
*
Jika anda asli Surabaya tulis ulang.
Your answer
No Telp Rumah
Contoh : (031) 7089232 (jika ada)
Your answer
No HP Pribadi
*
Apabila tidak punya, isi nomor saudara/kerabat dekat anda
Your answer
Email
*
Masukan email sering dipakai
Your answer
Email FB
Masukan email Facebook
Your answer
Twitter
Your answer
Submit
Clear form
Never submit passwords through Google Forms.
Forms
This content is neither created nor endorsed by Google.
Report Abuse
Terms of Service
Privacy Policy
Help and feedback
Contact form owner
Help Forms improve
Report