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BADAN EKSEKUTIF MAHASISWA

UNIVERSITAS PASIR PENGARAIAN


KABINET SDM UPP UNGGUL
Alamat: Sekretaris KM FE Lantai 3 - Kampus UPP - Jln.Tuanku Tambusai, Kumu Desa Rambah Hilir
Telp. 081397816713 Kode Pos 28557

FORMULIR PENDAFTARAN
CALON PENGURUS BEM
UNIVERSITAS PASIR PENGARAIAN

Yang bertanda tangan di bawah ini:


Nama : .........................................................................................................
Tempat /Tanggal Lahir : .........................................................................................................
Jenis Kelamin : .........................................................................................................
Semester/Kelas : .........................................................................................................
Tahun Angkatan : .........................................................................................................
Alamat/Domisili : .........................................................................................................
No.Hp/Wa : .........................................................................................................
Alamat e-mail : .........................................................................................................
Motto Hidup : .........................................................................................................

PENDIDIKAN
SD : .........................................Lulus Tahun: .........................................
SMP/MTS : .........................................Lulus Tahun: .........................................
SMA/MA/MAN : .........................................Lulus Tahun: .........................................

PENGALAM ORGANISASI
1. ....................................................................................................................................................
2. ....................................................................................................................................................
3. ....................................................................................................................................................
4. ....................................................................................................................................................
5. ....................................................................................................................................................

Pasir Pengaraian, Calon


Pengurus BEM FE
Universitas Pasir Pengaraian

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NIM.

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