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Pengajuan UKT Genap Tahun 2021
Mohon Dicermati Dengan Benar Data Yang Anda Isi
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Email
*
Your email
NIK
*
Your answer
NIM
*
Your answer
Semester
*
2
4
6
Nomor Kartu Keluarga
*
Your answer
Tanggal Lahir
*
MM
/
DD
/
YYYY
Nama Mahasiswa
*
Your answer
IPK
*
Your answer
Pergururuan Tinggi Asal
*
STIKES Widya Husada
Akademi Keperawatan Widya Husada
Akademi Fisioterapi Widya Husada
Program Studi
*
D3 Teknik Rontgen
D3 Refraksi Optisi
D3 Teknik Elektro Medik
D3 Keperawatan
D3 Fisioterapi
S1 Ilmu Keperawatan
S1 Perekam dan Informasi Kesehatan
Angkatan
*
2017
2018
2019
Alamat
*
Your answer
No WA ( no yang bisa dihubungi )
*
Your answer
Pekerjaan Ayah
*
Your answer
Pekerjaan Ibu
*
Your answer
Nama Ibu Kandung
*
Your answer
Penghasilan Kotor Ayah/Bulan
*
Your answer
Penghasilan Kotor Ibu/Bulan
*
Your answer
Jumlah Anggota Keluarga yang Ditanggung
*
Your answer
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