FORMULIR REGISTRASI BEASISWA

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Nama Lengkap (Full Name)*

Handphone (Mobile Phone)*

Alamat Email (Email Address)*

Kata Sandi (Password)*

Asal Sekolah (Origin Of High School)*

Provinsi Sekolah ( School Province )

Tahun Masuk Sekolah (Year Of Entering High School)*

Tahun Kelulusan (Year Graduated From High School)*

Jurusan Sekolah (School Major)*

Foto (photo)

Silahkan Pilih Lokasi dan Jurusan

Kampus (Campus)*

Pilih Jurusan 1 (Choose Campus Majors 1) *

Pilih Jurusan 2 (Choose Campus Majors 2)

Pilih Jurusan 3 (Choose Campus Majors 3)

Input Token*

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* Harus diisi (Must be filled)

Daftar (Register)