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Contoh Penggisian Form_pmdk_ak Hal 1

Contoh Penggisian Form_pmdk_ak Hal 1

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Published by: Herdis Haerusalam on Jun 12, 2011
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FORMULIR PENDAFTARAN CALON MAHASISWA BARU POLITEKNIK NEGERI BANDUNG JALUR PMDK PRESTASI AKADEMIK (AK) TAHUN AKADEMIK 2011

/2012
NAMA PESERTA INFORMASI KELAHIRAN TGL LAHIR KAB/KOTA
A B C D E F G H I J K L M N O P Q R S T U V A B C D E F G H I J K L M N O P Q R S T U V A B C D E F G H I J K L M N O P Q R S T U V A B C D E F G H I J K L M N O P Q R S T U V A B C D E F G H I J K L M N O P Q R S T U V A B C D E F G H I J K L M N O P Q R S T U V A B C D E F G H I J K L M N O P Q R S T U V A B C D E F G H I J K L M N O P Q R S T U V A B C D E F G H I J K L M N O P Q R S T U V

T A R I M
A B C D E F G H I J K L M N O P Q R S T U V A B C D E F G H I J K L M N O P Q R S T U V A B C D E F G H I J K L M N O P Q R S T U V A B C D E F G H I J K L M N O P Q R S T U V A B C D E F G H I J K L M N O P Q R S T U V A B C D E F G H I J K L M N O P Q R S T U V

D I M YA T I
A B C D E F G H I J K L M N O P Q R S T U V A B C D E F G H I J K L M N O P Q R S T U V A B C D E F G H I J K L M N O P Q R S T U V A B C D E F G H I J K L M N O P Q R S T U V A B C D E F G H I J K L M N O P Q R S T U V A B C D E F G H I J K L M N O P Q R S T U V A B C D E F G H I J K L M N O P Q R S T U V A B C D E F G H I J K L M N O P Q R S T U V A B C D E F G H I J K L M N O P Q R S T U V A B C D E F G H I J K L M N O P Q R S T U V 0 1 2 3

INFORMASI SEKOLAH ASAL SEKOLAH JURUSAN

2 6 0 4 9 3
0 1 2 3 4 5 6 7 8 9 0 1 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9

7 3 2
0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9

3 2 7 3 6 1 4 5
0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9

1 0 2
0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9

JENIS KELAMIN PESERTA
0

NOMOR INDUK SISWA (NIS)

0 8 0 9 1 0 2 6
0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9

LAKI-LAKI PEREMPUAN

1 2 3 4 5 6 7 8 9

W W W W W W W W W W W W W W W W W W W W W W W W W X Y Z X Y Z X Y Z X Y Z X Y Z X Y Z X Y Z X Y Z X Y Z X Y Z X Y Z X Y Z X Y Z X Y Z X Y Z X Y Z X Y Z X Y Z X Y Z X Y Z X Y Z X Y Z X Y Z X Y Z X Y Z

INFORMASI ALAMAT ALAMAT PESERTA

KAB/KOTA

KODE POS

PROGRAM STUDI PILIHAN PMDK

S A R I J A D I
A B C D E F G H I J K L M N O P Q R S T U V A B C D E F G H I J K L M N O P Q R S T U V A B C D E F G H I J K L M N O P Q R S T U V A B C D E F G H I J K L M N O P Q R S T U V A B C D E F G H I J K L M N O P Q R S T U V A B C D E F G H I J K L M N O P Q R S T U V A B C D E F G H I J K L M N O P Q R S T U V A B C D E F G H I J K L M N O P Q R S T U V A B C D E F G H I J K L M N O P Q R S T U V

F L A T
A B C D E F G H I J K L M N O P Q R S T U V A B C D E F G H I J K L M N O P Q R S T U V A B C D E F G H I J K L M N O P Q R S T U V A B C D E F G H I J K L M N O P Q R S T U V A B C D E F G H I J K L M N O P Q R S T U V

N O
A B C D E F G H I J K L M N O P Q R S T U V A B C D E F G H I J K L M N O P Q R S T U V A B C D E F G H I J K L M N O P Q R S T U V

1 3 5
A B C D E F G H I J K L M N O P Q R S T U V A B C D E F G H I J K L M N O P Q R S T U V A B C D E F G H I J K L M N O P Q R S T U V A B C D E F G H I J K L M N O P Q R S T U V

B
A B C D E F G H I J K L M N O P Q R S T U V A B C D E F G H I J K L M N O P Q R S T U V A B C D E F G H I J K L M N O P Q R S T U V A B C D E F G H I J K L M N O P Q R S T U V A B C D E F G H I J K L M N O P Q R S T U V A B C D E F G H I J K L M N O P Q R S T U V A B C D E F G H I J K L M N O P Q R S T U V A B C D E F G H I J K L M N O P Q R S T U V A B C D E F G H I J K L M N O P Q R S T U V

7 3 6
0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9

4 0 0 1 2
0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9

1 1 5 3
0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9

AK (1)

SDP (Rp)

3 0 0 0 0 0 0
0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9

W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W X Y Z 0 1 2 3 4 5 6 7 8 9 X Y Z 0 1 2 3 4 5 6 7 8 9 X Y Z 0 1 2 3 4 5 6 7 8 9 X Y Z 0 1 2 3 4 5 6 7 8 9 X Y Z 0 1 2 3 4 5 6 7 8 9 X Y Z 0 1 2 3 4 5 6 7 8 9 X Y Z 0 1 2 3 4 5 6 7 8 9 X Y Z 0 1 2 3 4 5 6 7 8 9 X Y Z 0 1 2 3 4 5 6 7 8 9 X Y Z 0 1 2 3 4 5 6 7 8 9 X Y Z 0 1 2 3 4 5 6 7 8 9 X Y Z 0 1 2 3 4 5 6 7 8 9 X Y Z 0 1 2 3 4 5 6 7 8 9 X Y Z 0 1 2 3 4 5 6 7 8 9 X Y Z 0 1 2 3 4 5 6 7 8 9 X Y Z 0 1 2 3 4 5 6 7 8 9 X Y Z 0 1 2 3 4 5 6 7 8 9 X Y Z 0 1 2 3 4 5 6 7 8 9 X Y Z 0 1 2 3 4 5 6 7 8 9 X Y Z 0 1 2 3 4 5 6 7 8 9 X Y Z 0 1 2 3 4 5 6 7 8 9 X Y Z 0 1 2 3 4 5 6 7 8 9 X Y Z 0 1 2 3 4 5 6 7 8 9 X Y Z 0 1 2 3 4 5 6 7 8 9 X Y Z 0 1 2 3 4 5 6 7 8 9 X Y Z 0 1 2 3 4 5 6 7 8 9 X Y Z 0 1 2 3 4 5 6 7 8 9 X Y Z 0 1 2 3 4 5 6 7 8 9 X Y Z 0 1 2 3 4 5 6 7 8 9 X Y Z 0 1 2 3 4 5 6 7 8 9

NO. TELP/ HANDPHONE

0 8 5 1 3 5 8 2 1 4 6 9
0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9

FORMULIR PENDAFTARAN PMDK POLBAN JALUR AKADEMIK (AK) TAHUN AKADEMIK 2011/2012 HALAMAN KE-1 DARI 2 HALAMAN

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