2016. formulir pendaftaran mahasiswa kkn
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8/17/2019 2016. Formulir Pendaftaran Mahasiswa KKN
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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
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