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Formulir Pendaftaran Ketua Osis

Formulir Pendaftaran Ketua Osis

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KOMISI PEMILIHAN UMUM ( KPU

)
ORGANISASI SISWA INTRA SEKOLAH ( OSIS )
SMP NEGERI 1 JATIROTO
Jalan. Jatiroto – Jatisrono, Wonogiri 57692
Email : osisespenjator@yahoo.co.id home page :
http:osissmpn!jatiroto."ordpress.com
FORMULIR PENDAFTARAN
CALON KETUA OSIS 2012/2013
#ama : $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$
%empat, %anggal &ahir : $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$
'lamat ()mah : $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$
*elas : $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$
#ama +rang %)a : $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$
#omor %elp. ,- : $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$
.ita / cita : $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$
0otto ,id)p : $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$
'lamat
1 E 0'2& : $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$
1 3'.E4++* : $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$
1 %W2%%E( : $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$
-E#5'&'0'# 4E(+(5'#26'62 : $$$$$$$$$$$$$$$$ Ja7atan $$$$$$$$$$$$$$$$
$$$$$$$$$$$$$$$$ Ja7atan $$$$$$$$$$$$$$$$
$$$$$$$$$$$$$$$$ Ja7atan $$$$$$$$$$$$$$$$
-(E6%'62
11 '*'8E02* : $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$
11 #+# '*'8E02* : $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$
9262 :

::::::::::::::::::::::::::::::::::::::::::::::
:::.

::::::::::::::::::::::::::::::::::::::::::::::
:::.
0262 :

::::::::::::::::::::::::::::::::::::::::::::::
:::.

::::::::::::::::::::::::::::::::::::::::::::::
:::.
KOMISI PEMILIHAN UMUM ( KPU )
ORGANISASI SISWA INTRA SEKOLAH ( OSIS )
SMP NEGERI 1 JATIROTO
Jalan. Jatiroto – Jatisrono, Wonogiri 57692
Email : osisespenjator@yahoo.co.id home page :
http:osissmpn!jatiroto."ordpress.com
Jatiroto ,::::., 6eptem7er 2;!2
.alon *et)a
<:::::::::::::::::::.=
#26. :::::
NB :
 (*) B!" #$#%&'(")
 (**) D* T'+,"- -$.-'++)
 FOTO 3/0 1"' %$.*("."-"' !"' D*$."2,"' *""- -$*- ( -&!* '"#" 13"!,
45-5))
FORMULIR PENDAFTARAN
CALON WAKIL KETUA OSIS 2012/2013
#ama : $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$
%empat, %anggal &ahir : $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$
'lamat ()mah : $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$
*elas : $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$
#ama +rang %)a : $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$
#omor %elp. ,- : $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$
.ita / cita : $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$
0otto ,id)p : $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$
'lamat
1 E 0'2& : $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$
1 3'.E4++* : $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$
1 %W2%%E( : $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$
-E#5'&'0'# 4E(+(5'#26'62 : $$$$$$$$$$$$$$$$ Ja7atan $$$$$$$$$$$$$$$$
$$$$$$$$$$$$$$$$ Ja7atan $$$$$$$$$$$$$$$$
$$$$$$$$$$$$$$$$ Ja7atan $$$$$$$$$$$$$$$$
-(E6%'62
11 '*'8E02* : $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$
11 #+# '*'8E02* : $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$
9262 :

::::::::::::::::::::::::::::::::::::::::::::::
:::.

::::::::::::::::::::::::::::::::::::::::::::::
:::.
0262 :
> ? @
KOMISI PEMILIHAN UMUM ( KPU )
ORGANISASI SISWA INTRA SEKOLAH ( OSIS )
SMP NEGERI 1 JATIROTO
Jalan. Jatiroto – Jatisrono, Wonogiri 57692
Email : osisespenjator@yahoo.co.id home page :
http:osissmpn!jatiroto."ordpress.com

::::::::::::::::::::::::::::::::::::::::::::::
:::.

::::::::::::::::::::::::::::::::::::::::::::::
:::.
Jatiroto ,::::., 6eptem7er 2;!2
.alon *et)a
<:::::::::::::::::::.=
#26. :::::
NB :
 (*) B!" #$#%&'(")
 (**) D* T'+,"- -$.-'++)
 FOTO 3/0 1"' %$.*("."-"' !"' D*$."2,"' *""- -$*- ( -&!* '"#" 13"!,
45-5))
SURAT I6IN ORANG TUA
Aang 7ertanda tangan di 7a"ah ini adalah orang t)a "ali sis"a1 dari :
#ama : ::::::::::::::::::::::::::::.
#26 : ::::::::::::::::::::::::::::.
*elas : ::::::::::::::::::::::::::::.
'lamat : ::::::::::::::::::::::::::::.
8engan ini mengijinBan anaB saya )nt)B mencalonBan diri menjadi Bet)a
+626WaBil *et)a +626 1. 8emiBian s)rat ijin ini Bami 7)at semoga dapat
menjadi maBl)m, atas perhatianya Bami )capBan terimaBasih.
Jatiroto, ::..6eptem7er 2;!2
+rang %)aWali
<:::::::::::::::=
> ? @
KOMISI PEMILIHAN UMUM ( KPU )
ORGANISASI SISWA INTRA SEKOLAH ( OSIS )
SMP NEGERI 1 JATIROTO
Jalan. Jatiroto – Jatisrono, Wonogiri 57692
Email : osisespenjator@yahoo.co.id home page :
http:osissmpn!jatiroto."ordpress.com
NOTE :
 (*) C5.$- ("'+ -1", %$.!&)

FOTO 3X4 dan persyaratan lain Diserahkan saat test ( tulis nama dibalik foto). MISI : . September 2012 Calon Ketua 3x4 (………………………………………………….) NIS.wordpress.. FORMULIR PENDAFTARAN CALON WAKIL KETUA OSIS 2012/2013 Nama Tempat. Wonogiri 57692 Email : osisespenjator@yahoo.co. / HP Cita . (**) Diisi Tingkat tertinggi.com Jatiroto .id home page : http://osissmpn1jatiroto.cita Motto Hidup Alamat * E MAIL * FACEBOOK * TWITTER PENGALAMAN BERORGANISASI : _______________________________________ : _______________________________________ : _______________________________________ : _______________________________________ : _______________________________________ : _______________________________________ : _______________________________________ : _______________________________________ : _______________________________________ : _______________________________________ : _______________________________________ : ________________ Jabatan ________________ ________________ Jabatan ________________ ________________ Jabatan ________________ PRESTASI ** AKADEMIK ** NON AKADEMIK VISI : _______________________________________ : _______________________________________ : ………………………………………………………………………………………………………………………… ……….KOMISI PEMILIHAN UMUM ( KPU ) ORGANISASI SISWA INTRA SEKOLAH ( OSIS ) SMP NEGERI 1 JATIROTO Jalan. …………… NB    : (*) Bila mempunyai. Tanggal Lahir Alamat Rumah Kelas Nama Orang Tua Nomor Telp. ………………………………………………………………………………………………………………………… ……….…………. Jatiroto – Jatisrono.

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