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ORGANISASI SISWA INTRA SEKOLAH (OSIS)

SMK BINA SARANA INDUSTRI


Jalan Raya Cipeundeuy No. 224 Kec. Cipeundeuy Kab. subang

FORMULIR PENDAFTARAN PENGURUS OSIS


SMK BINA SARANA INDUSTRI

Foto Ukuran
3x4

A. IDENTITAS PRIBADI
1. Nama Lengkap, panggilan : ...............................................................................................................
2. Tempat, tanggal lahir : ...............................................................................................................
3. Jenis kelamin : ...............................................................................................................
4. Agama : ...............................................................................................................
5. Alamat Lengkap : ...............................................................................................................
...............................................................................................................
6. No. Telepon / HP : (1.) (2.)
(3.) (4.)
7. Alamat E-mail , Facebook : ...............................................................................................................
8. Golongan Darah : ...............................................................................................................
9. Hobi : ...............................................................................................................
10. Cita-cita :
11. Asal Sekolah :

B. IDENTITAS ORANG TUA/ WALI


1. Jumlah Saudara : ...............................................................................................................
2. Anak Ke : ...............................................................................................................
3. Orang Tua
Ayah
Nama : ...............................................................................................................
Pekerjaan : ...............................................................................................................
No. Telepon : ...............................................................................................................
Ibu
Nama : ...............................................................................................................
Pekerjaan : ...............................................................................................................
No. Telepon : ...............................................................................................................
4. Alamat Orang Tua : ...............................................................................................................
...............................................................................................................
C. PRIBADI DAN ORGANISASI
1. Pengalaman Organisasi : 1. . 2. . 3. ..
yang pernah diikuti 4. . 5. . 6. ..
2. Alasan dan tujuan masuk OSIS: ...............................................................................................................
............................................................................................................
3. Program untuk kemajuan OSIS: ...............................................................................................................
............................................................................................................
4. Keterampilan yang dimiliki : ...............................................................................................................
...........................................................................................................
D. PERNYATAAN
1. Bersedia melaksanakan tugas dan kewajiban sebagai pengurus OSIS serta mengikuti dan menjalankan setiap
program yang telah diprogramkan OSIS SMK BINA SARANA INDUSTRI
2. Kami sebagai orang tua dengan ini MENYETUJUI / TIDAK MENYETUJUI * anak kami menjadi pengurus OSIS
SMK BINA SARANA INDUSTRI.

Menyetujui, .,
Orang Tua Siswa

( ... ) ( .. )

Keterangan :
*) Coret yang tidak perlu
Blangko ini diserahkan Panitia OSIS selambat-lambatnya pada Selasa, tgl 03 Oktober 2017