DAFTAR ISIAN DIRI

1. Nama

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

2. Tempat Lahir

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

3. Tanggal Lahir

:..................................................(Umur =

4. Alamat rumah

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

th)

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5. Alamat sekarang :........................................................................................................
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6. Suku bangsa

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

7. No. HP

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

8. E-mail

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

9. FB/Twitter

10.Keterangan Anggota Keluarga

No

Anggota
Keluarga

1.

Ayah

2.

Ibu

3.

Kakak

4.

Adik

Nama Lengkap

Pekerjaan

Agama

Pendidikan

11. Ceritakan sedikit tentang latar belakang dan kondisi keluargamu

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12. Makanan Favoritmu :..............................................................................................

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13. Minuman Favoritmu :..............................................................................................
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14. Ceritakan sedikit ttg minat dan bakatmu
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Apa Hobimu sekarang
a. Rekreasi :
b. Kesenian :
c. Olahraga :
d. Lain-Lain :
15. Prestasi yg pernah diraih :
a. ..............................................................................................................................
b. ..............................................................................................................................
c. ..............................................................................................................................
16. Organisasi/perkumpulan yg pernah diikuti :
a. ..............................................................................................................................
b. ..............................................................................................................................
c. .............................................................................................................................
21.Ceritakan sedikit motivasimu masuk ke FK Prodi Farmasi :
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22.Ceritakan sedikit kesulitan-kesulitan yang kamu hadapi sejak pertama kali masuk
hingga saat ini:
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23. Apa-apa saja yang disarankan setiap pertemuan :
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24. Ceritakan sedikit tentang ketertarikanmu kepada kegiatan ekstrakurikuler
(kepanitian, dll) terutama yang dilaksanakan oleh HMF :
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