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ORGANISASI SISWA INTRA SEKOLAH (OSIS)

MADRASAH ALIYAH NEGERI (MAN) 1 TANGERANG


JL. Arya Wangsakara. Desa Tapos Kecamatan Tigaraksa Kabupaten Tangerang Banten
Telp. (021)5991032 E-mail : man_3raksa@yahoo.co.id

FORMULIR PENDAFTARAAN PENGURUS OSIS


(MASA BAKTI 2019-2020)
MAN 1 TANGERANG
BIODATA PESERTA :
Nama Lengkap :...................................................................................................
Nama Panggilan :...................................................................................................
Tempat Tanggal Lahir :...................................................................................................
Motto Hidup :...................................................................................................
Kelas :...................................................................................................
Alamat :...................................................................................................
No hp/WA :...................................................................................................
Email :...................................................................................................
Jabatan yang diinginkan :...................................................................................................
Alasan masuk OSIS :...................................................................................................
....................................................................................................
Hobi :..................................................................................................
IDENTITAS ORANG TUA/WALI MURID :
Nama Ayah/Ibu/Wali :...................................................................................................
No. Telp :...................................................................................................
Alamat :...................................................................................................
....................................................................................................

Dengan mengisi Formulir Pendaftaraan Pengurus OSIS ini, maka saya


secara sadar tanpa paksaan dari pihak manapun, serta atas sepengetahuan
dan izin orang tua/wali murid untuk mengikuti Pendaftaraan Pengurus OSIS
Masa Bakti 2019-2020.
Tigaraksa, 15 Agustus 2019

Orang tua/Wali Murid Calon Pengurus OSIS

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