DAURAH MARHALAH I

KESATUAN AKSI MAHASISWA MUSLIM INDONESIA

(The Unity Action of Indonesian Moslem Students)

BIODATA PESERTA
DAURAH MARHALAH 1
6 S.D 7 AGUSTUS 2016

Nama lengkap :..

Nama panggilan :..........................................................................................................
TTL :..........................................................................................................
Univ/Fak/Jur/Angkt :..........................................................................................................
Jenis Kelamin :..........................................................................................................
Alamat Asal :..........................................................................................................
Alamat saat ini :..........................................................................................................
No.Telp/HP :..........................................................................................................
Email :..........................................................................................................
Tokoh Idola :..........................................................................................................
Alasan Mengidolakan :..........................................................................................................
Penyakit Kronis :..........................................................................................................
Alergi/Pantangan :..........................................................................................................
Golongan Darah :..........................................................................................................
Status Marital : 1. Menikah 2. Belum menikah 3. Janda/Duda
Pekerjaan :..........................................................................................................
Alamat Kantor :..........................................................................................................
Motto Hidup :..........................................................................................................

Riwayat Pendidikan
No. Jenjang Nama Instansi Alamat Periode
 DAURAH MARHALAH I
KESATUAN AKSI MAHASISWA MUSLIM INDONESIA
(The Unity Action of Indonesian Moslem Students)

Riwayat Organisasi
No. Nama Organisasi Jabatan Periode

Riwayat Pelatihan / Training

No. Nama Pelatihan/Training Pelaksana Periode

Buku, Tabloid, Majalah yang paling mempengaruhi dalam hidup/pola pikir

No. Buku Tabloid Majalah

Keahlian yang dimiliki

No. Keahlian yang dimiliki Mahir/Lumayan/kurang
 DAURAH MARHALAH I
KESATUAN AKSI MAHASISWA MUSLIM INDONESIA
(The Unity Action of Indonesian Moslem Students)

Biodata Orang tua

Ayah
Nama : .........................................................................................................
Unur : .........................................................................................................
Pendidikan terakhir : ..........................................................................................................
Pekerjaan : ..........................................................................................................
Organisasi : ..........................................................................................................
Afiliasi Politik : ..........................................................................................................
Alamat : ..........................................................................................................

Ibu
Nama : .........................................................................................................
Unur : .........................................................................................................
Pendidikan terakhir : ..........................................................................................................
Pekerjaan : ..........................................................................................................
Organisasi : ..........................................................................................................
Afiliasi Politik : ..........................................................................................................
Alamat : ..........................................................................................................

Biodata ini saya buat dengan sebenar-benarnya, dan Allah menjadi saksi saya
Jambi, 2016

FOTO
3X4 ( )