HIMPUNAN MAHASISWA SIPIL S-1

(CIVIL ENGINEERING SOCIETY OF STUDENT)

INSTITUT TEKNOLOGI NASIONAL
Bendungan Sigura-gura no. 2 Telp. (0341) 551431 Malang
e-mail : hms.itnmlg@gmail.com
fkmtsi_itnmlg@yahoo.co.id

KUISIONER MINAT DAN BAKAT MAHASISWA

TEKNIK SIPIL S-1 ITN MALANG
Kuisioner ini merupakan alat untuk menggali informasi mengenai minat dan bakat
mahasiswa/i teknik sipil S-1 Institut Teknologi Nasional Malang, untuk itu kami dari
pengurus HMS S-1 ITN Malang mengharapkan jawaban serta informasi yang benar-benar
obyektif berdasarkan dengan minat dan bakat yang anda miliki.
IDENTITAS PRIBADI
Nama Lengkap
NIM
Jurusan
Alamat Asal
Alamat di Malang
Semester
Agama
Tinggi/ Berat Badan
No. HP / No. Telp.
1.

:
:
:
:
:
:
:
:
:

Pas Photo
3x4

*ket :
foto dapat
menyusul
dikumpulkan di
RRBD

cm /

kg

Bakat apa yang anda miliki :

A. OLAHRAGA
1 ...................................

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

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

Alasan :
.......................................................................................................................................
.......................................................................................................................................
.......................................................................................................................................
.......................................................................................................................................
.......................................................................................................................................
.......................................................................................................................................
B. SENI & BUDAYA
1 ...................................

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

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

Alasan :
.......................................................................................................................................
.......................................................................................................................................
.......................................................................................................................................
.......................................................................................................................................
.......................................................................................................................................
.......................................................................................................................................

HIMPUNAN MAHASISWA SIPIL S-1

(CIVIL ENGINEERING SOCIETY OF STUDENT)

INSTITUT TEKNOLOGI NASIONAL
Jl. Bendungan Sigura-gura no. 2 Telp. (0341) 551431 Malang
e-mail : hms.itnmlg@gmail.co.id
fkmtsi_itnmlg@yahoo.co.id
2.

Minat apa yang ingin anda kembangkan :

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

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

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

Alasan :
..........................................................................................................................................
..........................................................................................................................................
..........................................................................................................................................
..........................................................................................................................................
..........................................................................................................................................
..........................................................................................................................................

3.

Prestasi apa yang pernah anda dapatkan :

Prestasi yang diperoleh

4.

Tingkat

Tahun

Agenda apa yang menurut anda perlu diadakan untuk seluruh mahasiswa sipil S-1 ITN
Malang terkait olahraga , seni atau budaya :
...............................................................
...............................................................
...............................................................
...............................................................

Karena sangat pentingnya kuisioner ini, maka diharapkan untuk mengisi dengan data yang valid.
Atas perhatian dan partisipasi seluruh mahasiswa teknik sipil S-1 kami ucapkan banyak terimakasih.

Malang,

NIM :

2015