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Formulir Pendaftaran Mahasiswa Online
A. Data Diri Mahasiswa Online
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Nama Lengkap*
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Tempat Lahir Dan tanggal lahir*
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Jenis kelamin*
Laki-Laki
Perempuan
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Agama*
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Asal Gereja*
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Status Pernikahan*
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Nama Pasangan
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Jumlah Anak
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Pekerjaan sebelumnya
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Keahlian khusus
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Warga negara*
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NIK*
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Asal negara
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Nomor Handphone*
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Alamat Lengkap*
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Kelurahan
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Kecamatan
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Kode Pos
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Kota/kab
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Provinsi
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Email
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Penerima KPS
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B.
Data Orang Tua/Wali Calon Mahasiswa
Ayah
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a. Nama*
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b. Tempat Tanggal Lahir*
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c. Alamat*
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d.
Pekerjaan*
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e.
Pendidikan
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f.
Tlp/Hp
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2. Nama Ibu*
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b.
Tempat Tanggal Lahir*
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c.
Alamat
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d.
Pekerjaan*
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e.
Pendidikan*
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f.
Tlp/Hp
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C.
Data Pendidikan Calon Mahasiswa
Opsi 1
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1. SD: ……….…………………………………….. tahun lulus ……………*
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SMA/SMK
:……………………………….…. tahun lulus ………*
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PT
:…………..… Jurusan ……..…. tahun lulus…….............
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Pendidikan Ketrampilan : ……..........… tahun lulus ………
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D. Data Tambahan
Opsi 1
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1. Program studi pilihan : *)
Teologi
Pendidikan Agama Kristen
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