BIODATA MAHASISWA KMK FEB UNIVERSITAS BRAWIJAYA
1. NAMA LENGKAP : ______________________________________________________
2. NAMA PANGGILAN : ______________________________________________________
3. NAMA BAPTIS : ______________________________________________________
4. NAMA KRISMA : ______________________________________________________
5. FAKULTAS/PROGRAM STUDI : __________________________/___________________________
6. JENIS KELAMIN : ______________________________________________________
7. TEMPAT DAN TANGGAL LAHIR : ______________________________________________________
8. AGAMA : ______________________________________________________
9. KEWARGANEGARAAN : ______________________________________________________
10. GOLONGAN DARAH : ______________________________________________________
11. ALAMAT DIMALANG : ______________________________________________________
_______________________ Tlp. : __________________________
12. EMAIL : ______________________________________________________
13. ID LINE : ______________________________________________________
14. JUMLAH SAUDARA KANDUNG :
KAKAK : ______________________________________________________
ADIK : ______________________________________________________
15. KEGEMARAN / HOBBY : 1. ____________________________________________________
2. ____________________________________________________
3. ____________________________________________________
16. PRESTASI : 1. ____________________________________________________
2. ____________________________________________________
3. ____________________________________________________
17. ORANG TUA
NAMA AYAH : ______________________________________________________
PENDIDIKAN TERAKHIR : ______________________________________________________
PEKERJAAN : ______________________________________________________
ALAMAT : ______________________________________________________
_______________________ Tlp. : __________________________
NAMA IBU : ______________________________________________________
PENDIDIKAN TERAKHIR : ______________________________________________________
PEKERJAAN : ______________________________________________________
ALAMAT : ______________________________________________________
_______________________ Tlp. : __________________________
Tanda tangan Mahasiswa
_____________________
Tempel pas foto
3X4