BIODATA
A.
MAHASISWA
Nama :....................................................................................................
Nim :....................................................................................................
Tempat /tanggal lahir :....................................................................................................
Jurusan/Prodi :....................................................................................................
Alamat :....................................................................................................
B.
ORANG TUA
1.AYAH
Nama :....................................................................................................
Umur :....................................................................................................
Pekerjaan :....................................................................................................
Pendapatan/bulan :....................................................................................................
Alamat :....................................................................................................
2.IBU
Nama :....................................................................................................
Umur :....................................................................................................
Pekerjaan :....................................................................................................
Pendapatan/bulan :....................................................................................................
Alamat :....................................................................................................
......................., 201
Mahasiswa
ybs
( ) NIM.
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