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HIMPUNAN MAHASISWA KIMIA (HIMAKI)

FAKULTAS MATEMATIKA DAN ILMU PENGETAHUAN ALAM


UNIVERSITAS SRIWIJAYA
Sekretariat: Jalan Raya Palembang-Prabumulih Gedung D2 lt.2
Jurusan Kimia FMIPA Unsri Inderalaya, 30662

PROGRAM PENDATAAN MAHASISWA KIMIA


ANGKATAN 2011
Biodata Pribadi
Nama

: Erisa Febriyani.................................................................
FOTO 3X4
Tempat/Tanggal Lahir : Jambi/24 Februari 1993.................................................
Alamat Tinggal/Kost

: Graha Mahasiswa I Taman Taruna


Sriwijaya Jl. Nusantara No.55 Rt.4 Rw.1
Lk.1 Kel. Simpang Timbangan,Indralaya Utara Ogan Ilir.
.................................................................

Asal Sekolah

:-

SD

: SD Negeri 74 Kota Jambi.....................

SMP : SMP Negeri 14 Kota Jambi........................

SMA : SMA Negeri 3 Kota Jambi..........................

Agama

: Islam.........................................................................

Hobi

: Menari,Melukis,Membaca...................................................

No. HP
Minat*

: 085377609311................................................................
:

Menulis

Elektronika

Berbicara/Pidato/MC

Progamer

Bermain alat musik* ..............

Desain Grafis

Olahraga* ...............................

Nasyid

Menyanyi

Menari

Comedy
Prestasi yang telah diraih

: 1. Juara 2 Tari Kreasi ................... Tahun 2010.......................


2. ................................................... Tahun .......................
3. ................................................... Tahun .......................
4. ................................................... Tahun .......................

Email

: .erisa_yups@ymail.com................................................

Asal Daerah

: Kota/Kabupaten .....Jambi........

Provinsi ..Jambi.......

Jabatan di HIMAKI

PPSDM

Internal

Minat dan Bakat

Eksternal

Danus

Infokom

Kesekretariatan
Dosen PA

Kajian Ilmiah

: Dra.Setiawati Yusuf,M.si...................................

HIMPUNAN MAHASISWA KIMIA (HIMAKI)


FAKULTAS MATEMATIKA DAN ILMU PENGETAHUAN ALAM
UNIVERSITAS SRIWIJAYA
Sekretariat: Jalan Raya Palembang-Prabumulih Gedung D2 lt.2
Jurusan Kimia FMIPA Unsri Inderalaya, 30662

Status

Menikah

Belum Menikah

Berat Badan

: ..51.... kg

Tinggi Badan

: ....158....... cm

Golongan Darah

: .....O......

Anak ke

: ....2....... dari ......3...... bersaudara

Motto Hidup

: Selalu bersyukur atas segala yang diberikan oleh Allah Swt.


Jangan mudah menyerah. Selalu ingat kata Orang
Tua.......... .....................................................................................
..............

Riwayat Organisasi
No.
1
2
3
4
5

: (mulai dari SMA sekarang)


Jabatan

Nama Organisai
PMR
Himaki

Wakil Sekretaris Himaki

Tahun
2010
2013/2014

Beasiswa**

: PPA............................................................................................

Golongan UKT***

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

Kemampuan Pembayaran

UKT***

Sangat Mampu
Mampu
Lemah

Kemampuan Pribadi

Management
Controling
Leadership

Ceritakan tentang diri Anda secara singkat :


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HIMPUNAN MAHASISWA KIMIA (HIMAKI)


FAKULTAS MATEMATIKA DAN ILMU PENGETAHUAN ALAM
UNIVERSITAS SRIWIJAYA
Sekretariat: Jalan Raya Palembang-Prabumulih Gedung D2 lt.2
Jurusan Kimia FMIPA Unsri Inderalaya, 30662

Cita-cita Anda

: 1. ..........................................................................................
2. ..........................................................................................

Biodata Orang Tua/Wali


A. Ayah
Nama

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

Tempat/Tanggal Lahir : .............................................................................................


Alamat

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

Pekerjaan

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

Agama

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

No. Telpon/HP

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

Penghasilan/bulan

: Rp .......................................................................................

B. Ibu
Nama

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

Tempat/Tanggal Lahir : .............................................................................................


Alamat

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

Pekerjaan

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

Agama

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

No. Telpon/HP

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

Penghasilan/bulan

: Rp .......................................................................................

C. Wali
Nama

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

Tempat/Tanggal Lahir : .............................................................................................


Alamat

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

Pekerjaan

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

Agama

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

No. Telpon/HP

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

Penghasilan/bulan

: Rp .......................................................................................

HIMPUNAN MAHASISWA KIMIA (HIMAKI)


FAKULTAS MATEMATIKA DAN ILMU PENGETAHUAN ALAM
UNIVERSITAS SRIWIJAYA
Sekretariat: Jalan Raya Palembang-Prabumulih Gedung D2 lt.2
Jurusan Kimia FMIPA Unsri Inderalaya, 30662

Inderalaya,

Mei 2014

Yang bersangkutan,

NIM.
Tembusan :
1. Pembantu Dekan III Bidang Kemahasiswaan
2. Ketua Jurusan Kimia
Catatan :
1. Isi dengan jujur dan sesuai fakta
2. * Boleh dicentang lebih dari satu (Minat)
3. ** Hanya untuk mahasiswa yang mendapat beasiswa
4. *** Khusus Angkatan 2013