by: adminJanuari 19, 2022Uncategorized Language Indonesian Registrasi Penerimaan Mahasiswa Baru STIKes Medika Nurul Islam Nomor Urut Hanya diisi oleh Petugas Registrasi Program Studi Please Select Sarjana Ilmu Keperawatan Profesi Ners Sarjana Farmasi Klinis Sarjana Kebidanan Profesi Bidan Diploma Tiga Kebidanan Jalur Pendaftaran Please Select Reguler Non Reguler KIP – Kuliah Biodata Mahasiswa Nama Nama Depan Nama Belakang Tempat Lahir Tanggal Lahir January February March April May June July August September October November December Month 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Day 2022 2021 2020 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 Year Jenis Kelamin Please Select Laki-Laki Perempuan Alamat Jalan Desa/Keluarahan Kecamatan Kabupaten Kode Pos Nomor HP 08xxxxxxxxxx E-mail example@example.com Penerima KIP-Kuliah Please Select Iya Tidak Nomor KIP-Kuliah Petugas Registrasi Pembawa BIodata Orang Tua Nama Ayah Nama Depan Ayah Nama Belakang Ayah Tempat Lahir Ayah Tanggal Lahir Ayah January February March April May June July August September October November December Month 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Day 2022 2021 2020 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 Year Janjang Pendidikan Ayah Please Select Tidak Sekolah Sekolah Dasar SLTP/Sederajat SLTA/Sederajat DI-DIII DIV/S1 >S2 Pekerjaan Ayah Penghasilan Ayah Please Select < Rp. 1.000.000 Rp. 1.000.000 – Rp. 2.500.000 > Rp. 2.500.000 Nama Ibu Nama Ibu Depan Nama Ibu Belakang Tempat Lahir Ibu Tanggal Lahir Ibu January February March April May June July August September October November December Month 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Day 2022 2021 2020 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 Year Janjang Pendidikan Ibu Please Select Tidak Sekolah Sekolah Dasar SLTP/Sederajat SLTA/Sederajat DI-DIII DIV/S1 >S2 Pekerjaan Ibu Penghasilan Ibu Please Select < Rp. 1.000.000 Rp. 1.000.000 – Rp. 2.500.000 > Rp. 2.500.000 Submit Should be Empty: Now create your own Jotform - It's free! Create your own Jotform