FORMULIR PENDAFTARAN

OPEN RECRUITMENT
HIMPUNAN MAHASISWA PENDIDIKAN BIOLOGI (HIMAPBIO)
PERIODE 2020

Foto 4x6

Nama : ______________________________________________
Tempat, tanggal, lahir : ______________________________________________
NPM : _______________________________________________
Jurusan : _______________________________________________
Fakultas : _______________________________________________
Alamat asli/ kosan : _______________________________________________
_______________________________________________
No Hp / Whatsapp : _______________________________________________
Sosial Media
a. Email : _______________________________________________
b. Facebook : ______________________________________________
c. Twitter : _______________________________________________
d. Intagram : _______________________________________________
Nilai IP : _______________________________________________
Nama Orang tua
a. Ayah : ______________________________________________
b. Ibu : ______________________________________________
No. HP Orang Tua : _______________________________________________
Prestasi Akademik & : 1. ___________________________________________
Non Akademik 2. ___________________________________________
3. ___________________________________________
Pengalaman : 1. ___________________________________________
Organisasi 2. ____________________________________________
3. ___________________________________________
 Divisi yang dipilih : 1. ___________________________________________
2. ____________________________________________
Kelebihan : ______________________________________________
______________________________________________
_______________________________________________
Kekurangan : ______________________________________________
_______________________________________________
_______________________________________________
Prinsip Hidup : _______________________________________________
_______________________________________________
_______________________________________________
Apakah Lulus
a. OMBUS 2019 : ______________________________________________
b. PPKM 2019 : ______________________________________________

Alasan Mengikuti HIMAPBIO ?

__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
Apa modal untuk masuk HIMAPBIO ?
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
Tasikmalaya, Hari,Tanggal, Januari 2020

Nama
NPM

Keterangan:
Adapun Divisi HIMAPBIO periode 2020:
1. Divisi Kemahasiswaan dan Kaderisasi
2. Divisi Penalaran dan Intelektual
3. Divisi Lingkungan Hidup
4. Divisi Kesejahteraan
5. Divisi Kerohanian