HIMPUNAN MAHASISWA MESIN

PERIODE 2019/2020
FAKULTAS TEKNIK UNIVERSITAS BRAWIJAYA
MALANG

FORMULIR PENDAFTARAN
CALON PENGURUS HMM FT – UB
PERIODE KEPENGURUSAN 2019/2020

I. BIODATA DIRI
Nama Lengkap : ........................................................
NIM : ........................................................
Angkatan : ........................................................
Tempat / Tanggal Lahir : ........................................................ Foto Terbaru
Jenis Kelamin : Pria / Wanita Berwarna
Agama : ........................................................ 4x6
Alamat Lengkap Asal : ........................................................
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Alamat di Malang : ........................................................
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IPK : ..................................................................................................
Nomer HP : ..................................................................................................
ID LINE ( Jika ada ) : ..................................................................................................
Email : ..................................................................................................
Hobby : ..................................................................................................
Motto Hidup : ..................................................................................................
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Visi : ..................................................................................................
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Misi : ..................................................................................................
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SEKRETARIAT HIMPUNAN MAHASISWA MESIN FT-UB MALANG

Jl. MT. Haryono no 167
Website: www.hmm.ub.ac.id E-mail: hmm@ub.ac.id
 HIMPUNAN MAHASISWA MESIN
PERIODE 2019/2020
FAKULTAS TEKNIK UNIVERSITAS BRAWIJAYA
MALANG

II. Data Riwayat Hidup

Riwayat Pendidikan
No Pendidikan Tempat Lulus Tahun
1 TK
2 SD
3 SMP
4 SMA/SMK
5 Lain-lain

Prestasi akademis dan non-akademis yang pernah diraih :

No Prestasi Tingkat Tahun

1
2
3
4
5

Pengalaman Organisasi

No Organisasi Jabatan Tahun

1
2
3
4
5

Pengalaman Kepanitiaan

No Nama Kepanitiaan Tingkat Tahun

1
2
3
4
5

SEKRETARIAT HIMPUNAN MAHASISWA MESIN FT-UB MALANG

Jl. MT. Haryono no 167
Website: www.hmm.ub.ac.id E-mail: hmm@ub.ac.id
 HIMPUNAN MAHASISWA MESIN
PERIODE 2019/2020
FAKULTAS TEKNIK UNIVERSITAS BRAWIJAYA
MALANG

Demikian formulir pendaftaran ini saya isi dengan jujur dan dalam keadaan sadar dan
sehat jasmani rohani serta tanpa ada paksaan dari pihak manapun. Saya bersedia menerima
konsekuensi di kemudian hari apabila saya melakukan kecurangan, manipulasi, atau
tindakan apapun yang tidak jujur dalam pengisian formulir ini.

Malang,.....................2019

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NIM .......................................

SEKRETARIAT HIMPUNAN MAHASISWA MESIN FT-UB MALANG

Jl. MT. Haryono no 167
Website: www.hmm.ub.ac.id E-mail: hmm@ub.ac.id
 HIMPUNAN MAHASISWA MESIN
PERIODE 2019/2020
FAKULTAS TEKNIK UNIVERSITAS BRAWIJAYA
MALANG

Jawablah dengan jujur, sesuai Hati Nurani anda

1. Deskripsikan secara sederhana tentang diri anda, kelemahan dan kekurangan yang anda
miliki.
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2. Potensi, bakat, atau kemampuan apa yang terdapat dalam diri anda yang bisa anda
manfaatkan dan kembangkan dengan menjadi pengurus HMM FT – UB ?
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3. Tuliskan menurutkan anda, apa itu skala prioritas? Sertakan skala prioritas dalam hidup
anda.
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SEKRETARIAT HIMPUNAN MAHASISWA MESIN FT-UB MALANG

Jl. MT. Haryono no 167
Website: www.hmm.ub.ac.id E-mail: hmm@ub.ac.id
 HIMPUNAN MAHASISWA MESIN
PERIODE 2019/2020
FAKULTAS TEKNIK UNIVERSITAS BRAWIJAYA
MALANG

4. Bidang manakah yang anda minati?

Pilihan 1 :....................................................................................................................
Pilihan 2 :....................................................................................................................
Alasan Pilihan 1:
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Alasan Pilihan 2:
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5. Menurut anda, tugas apa saja yang akan anda kerjakan di bidang yang anda pilih?
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6. Apa saja yang ingin anda berikan untuk himpunan, khususnya di bidang yang anda
pilih?
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SEKRETARIAT HIMPUNAN MAHASISWA MESIN FT-UB MALANG

Jl. MT. Haryono no 167
Website: www.hmm.ub.ac.id E-mail: hmm@ub.ac.id
 HIMPUNAN MAHASISWA MESIN
PERIODE 2019/2020
FAKULTAS TEKNIK UNIVERSITAS BRAWIJAYA
MALANG

7. Deskripsikan secara sederhana dan menarik, pandangan anda tentang HMM FT - UB

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8. Seperti apa HMM FT – UB yang anda harapkan dan impikan?
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9. Seberapa yakin anda ingin menjadi pengurus HMM FT – UB ? Komitmen apa yang
dapat anda berikan jika anda menjadi pengurus HMM FT – UB
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SEKRETARIAT HIMPUNAN MAHASISWA MESIN FT-UB MALANG

Jl. MT. Haryono no 167
Website: www.hmm.ub.ac.id E-mail: hmm@ub.ac.id
 HIMPUNAN MAHASISWA MESIN
PERIODE 2019/2020
FAKULTAS TEKNIK UNIVERSITAS BRAWIJAYA
MALANG

10. Bagaimana cara anda dalam memanajemen waktu jika anda terpilih menjadi pengurus
HMM FT – UB yang yang penuh dengan kegiatan organisasi?
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11. Berikan opini singkat anda tentang ‘ Berkuliah untuk akademis atau organisasi? ‘
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12. Apa saja aktifitas dan kesibukan anda?
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SEKRETARIAT HIMPUNAN MAHASISWA MESIN FT-UB MALANG

Jl. MT. Haryono no 167
Website: www.hmm.ub.ac.id E-mail: hmm@ub.ac.id
 HIMPUNAN MAHASISWA MESIN
PERIODE 2019/2020
FAKULTAS TEKNIK UNIVERSITAS BRAWIJAYA
MALANG

13. Jika anda memiliki dua tanggung jawab yang mendesak, antara kuliah dan menghadiri
acara besar mewakili HMM FT - UB mana yang akan anda pilih? Jelaskan alasannya.
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14. Dalam suatu organisasi, sifat-sifat apa saja yang diperlukan oleh anggota pengurusnya?
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15. Menurut anda, dalam organiasi manakan hal yang lebih baik, kekeluargaan atau
profesionalisme?
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SEKRETARIAT HIMPUNAN MAHASISWA MESIN FT-UB MALANG

Jl. MT. Haryono no 167
Website: www.hmm.ub.ac.id E-mail: hmm@ub.ac.id
 HIMPUNAN MAHASISWA MESIN
PERIODE 2019/2020
FAKULTAS TEKNIK UNIVERSITAS BRAWIJAYA
MALANG

16. Apakah anda bersedia menerima rekomendasi untuk di tempatkan di bidang lain?
Bidang apa?
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17. Apa hal yang harus diperbaiki dari HMM FT – UB ?
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18. Apa anda siap menjalankan dan memperjuangkan amanah dari HMM FT – UB dengan
penuh komitmen dan tanggung jawab? Jelaskan alasannya
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SEKRETARIAT HIMPUNAN MAHASISWA MESIN FT-UB MALANG

Jl. MT. Haryono no 167
Website: www.hmm.ub.ac.id E-mail: hmm@ub.ac.id
 HIMPUNAN MAHASISWA MESIN
PERIODE 2019/2020
FAKULTAS TEKNIK UNIVERSITAS BRAWIJAYA
MALANG

NB
- Kerjakan dengan tulisan tangan ( pulpen hitam )
- Surat Lulus PROBINMABA
- KRS dan KHS terbaru
- Kumpulkan semua data dengan map bening berwarna merah
- Lampirkan Surat Rekomendasi Magang HMM FT-UB ( jika ada )
- Dikumpulkan di Sekretariat HMM FT – UB paling lambat 26 Maret 2019 pukul 23.59

SEKRETARIAT HIMPUNAN MAHASISWA MESIN FT-UB MALANG

Jl. MT. Haryono no 167
Website: www.hmm.ub.ac.id E-mail: hmm@ub.ac.id
 HIMPUNAN MAHASISWA MESIN
PERIODE 2019/2020
FAKULTAS TEKNIK UNIVERSITAS BRAWIJAYA
MALANG

SURAT PERNYATAAN
CALON PENGURUS HIMPUNAN MAHASISWA MESIN
FAKULTAS TEKNIK UNIVERSITAS BRAWIJAYA
PERIODE KEPENGURUSAN 2019/2020

Yang bertanda tangan di bawah ini:

Nama Lengkap : ................................................................................................
NIM : ................................................................................................
Angkatan : ................................................................................................
Tempat / Tanggal Lahir : ................................................................................................
Jenis Kelamin : (Pria / Wanita)*
Agama : ................................................................................................
Alamat Lengkap Asal : ................................................................................................
Alamat di Malang : ................................................................................................

Dengan ini saya menyatakan ( kesediaan / tidak bersedia)* untuk menerima dan amanah
yang diberikan kepada saya sebagai pengurus HMM FT UB periode 2019/2020, dan saya
berjanji akan melaksanakan dan memperjuangkan amanah tersebut dengan penuh tanggung
jawab.
Surat pernyataan ini saya buat dengan sebenar-benarnya, keadaan sadar, dan tanpa ada
paksaan dari pihak manapun.
Malang, ..........................2019
Saya yang bertanda tangan dibawah ini,

(.................................................)
NIM. ..........................................
*Coret yang tidak perlu

SEKRETARIAT HIMPUNAN MAHASISWA MESIN FT-UB MALANG

Jl. MT. Haryono no 167
Website: www.hmm.ub.ac.id E-mail: hmm@ub.ac.id