Formulir Mahasiswa Baru 2017
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SEKOLAH TINGGI AGAMA BUDDHA (STAB) BODHI DHARMA SK. Dirjen Bimas Buddha No. DJ.VI/16A/SK/2008 Anggota IABU (International Association of Buddhist Universities) Terakreditasi BAN-PT No.396/SK/BAN-PT/Akred/S/X/2014 Tanggal 11 Oktober 2014 FORMULIR PENDAFTARAN MAHASISWA BARU PROGRAM STUDI DHARMA ACHARIYA TAHUN AKADEMIK 2017/2018 (Diisi dengan huruf balok) Nomor Pendaftaran 1. Nama Mahasiswa 2. Tempat Lahir 3. Tanggal Lahir 4. Jenis Kelamin 5. Agama 6. Kewarganegaraan 7. No. KTP 8. Alamat Rumah Kelurahan Kecamatan Kode Pos 9. Telp./HP 10. Email 11. Pendidikan Terakhir 12. Orang Tua Nama Ayah Tanggal Lahir Pendidikan Pekerjaan Nama Ibu Tanggal Lahir Pendidikan Pekerjaan : ………………………….. : .......................................................................................................... : .......................................................................................................... : .......................................................................................................... : .......................................................................................................... : .......................................................................................................... : .......................................................................................................... : .......................................................................................................... : .......................................................................................................... : .......................................................................................................... : .......................................................................................................... : .......................................................................................................... : .......................................................................................................... : .......................................................................................................... : .......................................................................................................... : .......................................................................................................... : .......................................................................................................... : .......................................................................................................... : .......................................................................................................... : .......................................................................................................... : .......................................................................................................... : .......................................................................................................... : .......................................................................................................... Medan, ………………………… 2017 Mahasiswa ( ____________________________ ) Alamat Kampus: Jl. Selam No. 23 L Medan 20226 Telp. (061) 7368129, E-mail: [email protected] Website: www.stabbodhidharma.ac.id