THE NEW YOU INSTITUTE

Office :Jl. Samanhudi no. 121, Mutihan, Sondakan, Laweyan, Surakarta

Telp. (0271) 79 37 8 47. web address: www.thenewyouinstitute.com
FORMULIR PENDAFTARAN BEASISWA
PENGGERAK WIRAUSAHA SOSIAL
INFORMASI DASAR
Nama Lengkap

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Jenis Kelamin

Laki-laki

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Alamat Rumah

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Kabupaten Kota

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PROFIL ONLINE
Website/Blog

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FB Profile

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Twitter Profile

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Whats App

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E-mail

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INFORMASI KONTAK
No HP

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Telepon Rumah

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Pin BB

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PROFIL PENDIDIKAN
Asal Sekolah/Kampus :............................................................................................................................................
Nama Jurusan

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Tahun Masuk

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Kelas/Semester

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NEM/IPK

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PENGALAMAN ORGANISASI
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THE NEW YOU INSTITUTE

Office :Jl. Samanhudi no. 121, Mutihan, Sondakan, Laweyan, Surakarta
Telp. (0271) 79 37 8 47. web address: www.thenewyouinstitute.com
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PELATIHAN/WORKSHOP/ KEGIATAN ILMIAH
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PRESTASI
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Bersama dengan pengisian formulir ini. Saya menyatakan bersedia untuk melengkapi syarat pengajuan
beasiswa Penggerak Wirausaha Sosial yang diberikan oleh The New You Institue, dan saya bersedia bergabung
bersama tim The New You Institute dan Yayasan Semangat Membangun Indonesia Hebat untuk membangun
potensi diri saya dan secara bersamaan turut berkontribusi nyata membangun kesejahteraan masyarakat di
Indonesia melalui kegiatan wirausaha social.

,2013
Pemohon Beasiswa

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