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FORM PENDAFTARAN MAHASISWA BARU STIE YAPIS MERAUKE
MOHON ISI DENGAN SEBENARNYA DAN MENGGUNAKAN HURUF KAPITAL
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NAMA LENGKAP
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NAMA PANGGILAN
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TEMPAT TANGGAL LAHIR
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NAMA SUKU
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AGAMA
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ISLAM
K. KATOLIK
K. PROTESTAN
HINDU
BUDHA
N0. NIK (KTP)
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NO. KK
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NAMA IBU KANDUNG
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ASAL SEKOLAH
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TAHUN LULUS
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ALAMAT TINGGAL
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KONTAK (NO HP)
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