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Universitas Medan Area
Formulir Pendataan Alumni Periode I Tahun 2021
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Data Pokok
Nomor Pokok Mahasiswa (Contoh: 168160001)
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Your answer
Nama Lengkap Sesuai Ijazah (Contoh : Ahmad Bahrijal)
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Your answer
Fakultas / Program Studi
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Sipil
Elektro
Mesin
Arsitektur
Industri
Informatika
DATA PRIBADI
Tempat / Tanggal Lahir (Contoh: Medan/ 12 September 1997)
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Your answer
Agama (Contoh: Islam)
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Your answer
Status Perkawinan (Lajang / Menikah)
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Your answer
Jenis Kelamin (Laki - Laki / Perempuan)
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Golongan Darah (Contoh: O)
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Alamat (Contoh: Jl. Sisingamangaraja No. 1 Gg. Cempaka)
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Kelurahan / Kecamatan / Kota (Contoh: Medan Petisah/Medan)
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Your answer
Telepon / Hp (Contoh: 082225256969)
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Email (Mohon isi dengan benar)
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Your answer
Data Pekerjaan (Isi Jika Ada)
Pekerjaan
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Instansi
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Alamat Instansi / Perusahaan
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Kelurahan/Kecamatan/Kota
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Telepon / Fax email
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Email
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Data Orang Tua / Wali
Nama Orang Tua / Wali
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Pekerjaan
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Alamat
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Kelurahan / Kecamatan / Kota
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Your answer
Telepon / HP
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