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Data Mahasiswa Bidik Misi 2010
silakan isi data-data diri anda, upayakan agar semua terisi dengan lengkap sesuai dengan data diri anda.
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* Indicates required question
Nama Lengkap
*
Your answer
NPM
*
Your answer
Jenis Kelamin
*
Laki - laki
Perempuan
Fakultas
*
tuliskan fakultas anda secara lengkap, bukan singkatan (ex: ilmu komunikasi)
Your answer
Jurusan
*
Your answer
Tempat Lahir
*
Your answer
Tanggal Lahir
*
format dd mm-yyyy (ex: 19 April 1994)
Your answer
Alamat Rumah
*
Tulis selengkap-lengkapnya
Your answer
Asal Sekolah
*
Your answer
Nomor Handphone
*
Your answer
Email
*
Your answer
Email Facebook
Your answer
Twitter
*
isi tanpa tanda "@"
Your answer
Nama Ayah
*
Your answer
Pekerjaan Ayah
*
Your answer
Nama Ibu
*
Your answer
Pekerjaan Ibu
*
Your answer
No Handphone Orangtua
*
Your answer
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