Formulir Pendaftaran STIPAR by Ratnatri

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									                                              No. Pendaftaran :

                          FORMULIR PENDAFTARAN MAHASISWA BARU
                        SEKOLAH TINGGI ILMU PARIWISATA PANGANDARAN


1. Nama Lengkap                    : .......................................................................................
  Nama Panggilan                   : .......................................................................................
  Jenis Kelamin                    : ......................................................................................
  Tempat Tanggal Lahir             : ......................................................................................
  Agama                            : ......................................................................................
  Pendidikan Terakhir
  Nama Sekolah                     : ......................................................................................
  Jurusan                          : ......................................................................................
  Tahun Lulus                      : ......................................................................................
  Alamat Rumah                     : ......................................................................................
                                    .................... RT …….. RW …….. Kode Pos ……………
                                   Tlp. ...................................Fax. …………………………..
  Alamat Kantor                    : ......................................................................................
                                    .................... RT …….. RW …….. Kode Pos ……………
                                   Tlp. ...................................Fax. …………………………..
  Pilihan Program Studi            :          D-3 MANAJEMEN PERHOTELAN
                                              S-1 DESTINASI PARIWISATA
2. Orang Tua/Wali
  Nama                             : .....................................................................................
  Alamat Orang Tua/Wali : .....................................................................................
  Pekerjaan                        : .....................................................................................


                                                                    PANGANDARAN,………………………..




                      Pas poto
                        3X4
                                                                    …………………………………………..
                                                                    Calon Mahasiswa
                                             STIPAR PANGANDARAN
                           SEKOLAH TINGGI ILMU PARIWISATA PANGANDARAN
                         Alamat: Jln.Raya PANGANDARAN,No528 Tlp.(081313839656)
                                           PANGANDARAN 46385


                                                        USULAN BEA SISWA

1. Nama Lengkap                    : .......................................................................................
  Nama Panggilan                   : .......................................................................................
  Jenis Kelamin                    : ......................................................................................
  Tempat Tanggal Lahir             : ......................................................................................
  Agama                            : ......................................................................................
  Pendidikan Terakhir
  Nama Sekolah                     : ......................................................................................
  Jurusan                          : ......................................................................................
  Tahun Lulus                      : ......................................................................................
  Alamat Rumah                     : ......................................................................................
                                    .................... RT …….. RW …….. Kode Pos ……………
                                   Tlp. ...................................Fax. …………………………..


  Pilihan Program Studi            :          D-3 MANAJEMEN PERHOTELAN
                                              S-1 DESTINASI PARIWISATA
2. Orang Tua/Wali
  Nama                             : .....................................................................................
  Alamat Orang Tua/Wali : .....................................................................................
  Pekerjaan                        : .....................................................................................


                                                                    PANGANDARAN,………………………..




                   Pas poto
                     3X4

                                                                    …………………………………………..
                                           STIPAR PANGANDARAN
                               SEKOLAH TINGGI ILMU PARIWISATA PANGANDARAN
                                Alamat: Jln.Raya Padaherang,No.506 Tlp.(0265) 656529
                                                PADAHERANG 46384

                                      DAFTAR NOMINATIF USULAN BEA SISWA
                     Tempat/tanggal    Jenis                          Pekerjaan Orang
Nomor   NPM   Nama                              Nama Orang Tua/Wali                     Kontac ferson   Photo
                         lahir        Kelamin                            Tua/Wali
  1      2     3           4             5              6                    7               8           9



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     Pangandaran, 17 Pebruari 2011
               Direktur,




       Prof. Dr.HM. AHMAN SYA
       NIP.19580612 198303 1 004

								
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