Form SURAT PENGAJUAN BEASISWA LAZISMU

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Perihal : Pengajuan Beasiswa

Kepada :
Yth.Pimpinan Lazismu Jawa Barat
Di
Tempat

Assalamu’alaikum Wr. Wb.


Yang bertanda tangan di bawah ini :
Nama : ................................................................................................
Tempat, Tanggal, Lahir : ................................................................................................
NIM : ................................................................................................
Semester : ................................................................................................
IPK : ................................................................................................
Alamat : ................................................................................................
................................................................................................
................................................................................................
Nama Orang Tua/Wali : ................................................................................................
Perkerjaan : ................................................................................................
Penghasilan : ................................................................................................
Alamat : ................................................................................................
................................................................................................
................................................................................................
Bermaksud untuk mengajukan beasiswa : .....................................................................

Demikian surat permohonan ini dibuat. Atas perhatian Bapak/Ibu saya ucapkan terima kasih.
Wassalamu’alaikum Wr.Wb

Bandung, .......,...................,............
Pemohon

................................................
BIODATA CALON PENERIMA BEASISWA

DATA MAHASISWA
Nama : ................................................................................................
NIM : ................................................................................................
Semester : ................................................................................................
Tempat,Tanggal Lahir : ................................................................................................
Jenis Kelamin : ................................................................................................
Agama : ................................................................................................
Alamat : ................................................................................................
................................................................................................
PRESTASI AKADEMIK
1. IPK : ................................................................................................
2. Organisasi : a. ...........................................................................................
b. ...........................................................................................
c. ...........................................................................................
3. Prestasi : a. ...........................................................................................
b. ...........................................................................................
c. ...........................................................................................
DATA ORANGTUA/WALI
Nama Orangtua/Wali : ................................................................................................
Perkerjaan : ................................................................................................
Penghasilan : ................................................................................................
Alamat : ................................................................................................
................................................................................................

Bandung,.........,....................2019
Orangtua/ Wali Calon Penerima Beasiswa

....................................... .................................................

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