Formulir Pendaftaran

Pengurus HIMAPPKn UNIWARA

Periode 2021-2022

Pas Foto
4X6

A. DATA DIRI
Nama Lengkap : .........................................................................................................................
Nama Panggilan : .......................................................................................................................
Tempat/Tanggal Lahir : ............................................................................................................
Umur : .........................................................................................................................................
Jenis Kelamin : Laki-Laki/Perempuan*
Alamat Lengkap : .......................................................................................................................
Agama : .......................................................................................................................................
Hobi : ...........................................................................................................................................
Nomor WhatsApp : ....................................................................................................................
Instagram : ..................................................................................................................................
Alasan Bergabung : ....................................................................................................................
.......................................................................................................................................................
.......................................................................................................................................................
B. RIWAYAT PENDIDIKAN
SD : ..............................................................................................................................................
SMP : ...........................................................................................................................................
SMA : ..........................................................................................................................................
Saat Ini : ......................................................................................................................................
C. RIWAYAT ORGANISASI
No Nama Organisasi Jabatan Tahun
.

D. PRESTASI YANG PERNAH DIRAIH

No Nama Kompetisi Keterangan Tahun
.

CP : 085606283243 (Kak Siwi)

NB : Coret Yang Tidak Perlu*