KEMENTRIAN KESEHATAN REPUBLIK INDONESIA

POLITEKNIK KESEHATAN BENGKULU JURUSAN KEPERAWATAN

HIMPUNAN MAHASISWA JURUSAN KEPERAWATAN
Jalan Indra Giri Nomor 03 Padang Harapan Kota Bengkulu 38225

FORMULIR PENDAFTARAN
CALON PENGURUS HIMPUNAN MAHASISWA JURUSAN (HMJ) KEPERAWATAN
POLTEKKES KEMENKES BENGKULU PERIODE 2020

Yang bertanda tangan dibawah ini :

Nama : .......................................................................................
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No Hp : .......................................................................................
Alamat Email : .......................................................................................
Live Skill : .......................................................................................
Motto Hidup : .......................................................................................
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Riwayat Pendidikan :
Tingkat Nama Lembaga Tahun Masuk Tahun Lulus
SD/MI
SLTP
SLTA

Organisasi yang Pernah Diikuti :

No Organisasi Jabatan Masa Aktif
 KEMENTRIAN KESEHATAN REPUBLIK INDONESIA
POLITEKNIK KESEHATAN BENGKULU JURUSAN KEPERAWATAN
HIMPUNAN MAHASISWA JURUSAN KEPERAWATAN
Jalan Indra Giri Nomor 03 Padang Harapan Kota Bengkulu 38225

DIVISI/POSISI YANG DIINGINKAN

1. Ketua 8. Divisi Kedisiplinan

2. Wakil Ketua 9. Divisi Kerohanian
3. Sekretaris 10. Divisi Kesenian
4. Bendahara 11. Divisi Pendidikan
5. Divisi Kaderisasi 12. Divisi Ekonomi dan Bisnis
6. Divisi Komunikasi dan Informasi 13. Divisi Olahraga dan Bakat
7. Divisi Pengabmas

PILIHAN UTAMA
Divisi :
Alasan :
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Rekomendasi Kegiatan :
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Saran (Pengembangan ) :
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PILIHAN CADANGAN
Divisi :
Alasan :
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Rekomendasi Kegiatan :
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Saran (Pengembangan ) :
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