JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Pendaftaran Program 2+i 2021 Politeknik Negeri Samarinda
Selambat-lambatnya tanggal 2 Mei 2021
Contact Person: 0877-4113-4238 (Rahma)
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Nama Lengkap
*
Your answer
No WhatsApp
*
Your answer
NIM
*
Your answer
Jurusan
*
Your answer
Program Studi
*
Your answer
Apakah saudara/i sudah lulus dari Polnes?
*
Ya
Tidak
Tahun masuk kuliah
*
Your answer
Tahun kelulusan
Your answer
Alasan ingin mengikuti program
*
Your answer
Apakah orang tua saudara/i mengijinkan untuk mengikuti program ini?
*
Ya
Tidak
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Politeknik Negeri Samarinda.
Report Abuse
Forms
