Wisma Kali Metro

Jl. Joyosuko Metro No. 42 A Merjosari, Malang

Telp :0341-573650
e-mail : mcw.malang@gmail.com
website : www.mcw-malang.org

FORMULIR PENDAFTARAN RELAWAN BARU

1. Identitas

Nama : ..........................................................................................................................
Tempat & tanggal lahir :...........................................................................................................................
Alamat asal :...........................................................................................................................
............................................................................................................................
Alamat sekarang :...........................................................................................................................
............................................................................................................................
Agama :..........................................................................................................................
No. Telp/Hp :...........................................................................................................................
Alamat Email :...........................................................................................................................

2. Riwayat Pendidikan

SD .............................................................................................. Lulus Tahun ...........................

SMP .............................................................................................. Lulus Tahun............................
SMA .............................................................................................. Lulus Tahun ...........................
PT/Fak .............................................................................................. Semester...................................

3. Pengalaman Organisasi

a. ............................................................................ Jabatan ........................................Tahun ....................

b. ............................................................................ Jabatan ........................................Tahun ....................
c. ............................................................................ Jabatan ........................................Tahun ....................
d. ............................................................................ Jabatan ........................................Tahun ....................
e. ............................................................................ Jabatan ........................................Tahun ....................
f. ............................................................................ Jabatan ........................................Tahun ....................

Bersama Rakyat Berantas Korupsi

 Wisma Kali Metro
Jl. Joyosuko Metro No. 42 A Merjosari, Malang
Telp :0341-573650
e-mail : mcw.malang@gmail.com
website : www.mcw-malang.org

4. Karya Tulis/Ilmiah
a. ........................................................................................................................................................................
b. ........................................................................................................................................................................
c. ........................................................................................................................................................................
d. ........................................................................................................................................................................
e. ........................................................................................................................................................................

5. Apa motivasi anda mengikuti Sekolah Antikorupsi?

6. Harapan anda kedepan menjadi relawan Antikorupsi?

Malang, ..........,...........................2016

Hormat saya
foto 3x4 foto 3x4

(..............................................................)

Bersama Rakyat Berantas Korupsi

 Wisma Kali Metro
Jl. Joyosuko Metro No. 42 A Merjosari, Malang
Telp :0341-573650
e-mail : mcw.malang@gmail.com
website : www.mcw-malang.org

Adapun persyaratan atau ketentuan pendaftaran diantaranya adalah:

1) Mengisi Formulir pendaftaran (download di web MCW: www.mcw-
malang.org)
2) Membuat satu buah essai 1500 kata/maksimal dengan tema:
Generasi Antikorupsi
3) Format penulisan Esai:
a. Judul Merepresentasikan Tema
b. Spasi 1,5
c. Jenis Font: Times New Roman
d. Ukuran Font: 12
e. Margin: Normal
4) Formulir pendaftaran dan esai dikumpulkan dalam format hardcopy ke
sekretariat MCW sebelum tanggal 21 Februari 2016

Bersama Rakyat Berantas Korupsi