8/17/2019 2016. Formulir Pendaftaran Mahasiswa KKN

1/1

 

Padang,........................20....Ketua BP-KKN Unand

Ub. Penerima Pendaftaran,

Catatan: 

Harap diisi dengan huruf balok/diketik ( )

FORMULIR PENDAFTARAN MAHASISIWA

PESERTA KKN UNIVERSITAS ANDALAS

TAHUN AKADEMIK 2015/2016

 Nomor:

Saya yang bertanda tangan di bawah ini :

 Nama :..................................... ........................................ ..................................... ........................................ .......

 Nomor B.P. :..................................... ........................................ ..................................... ........................................ .......

Tempat /Tgl Lahir :.................................... ......../.................................. ...................................... ....................................... .....

Jenis Kelamin :..................................... ........................................ ..................................... ........................................ .......

Agama :.................................................................................................................................................................

Fakultas :.................................................................................................................................................................

Jurusan/Prog.Studi :.........................................../.....................................................................................................................

Alamat di Padang :..................................... ........................................ ..................................... ........................................ .......

Telp/Hp :.................................................................................................................................................................

Email :.................................................................................................................................................................

Jenis KKN :..................................... ........................................ ......................................... .................................... .......

Dengan ini menyatakan mendaftarkan diri, menjadi peserta Kuliah Kerja Nyata (KKN) Universitas Andalas tahun akademik 2015/2016

Padang,............................20...........

Saya yang mendaftar,

Catatan: (__________________)Tempelkan pas foto terbaru No. BP

Ukuran 3x4 sebanyak 3 buah

......................................................................................................................................................................................................................

KARTU PESERTA KKN

MAHASISWA UNIVERSITAS ANDALAS

TAHUN AKADEMIK 2015 / 2016

 Nomor :

 Nama :...................................... ........................................ ........................................ ....

 Nomor :............................... ........................................ ......................................... ...........

Fakultas :............................................................................................................................

Pas Foto

3 x 4

Pas Foto

3x4