KOMISI PEMILIHAN RAYA (KPR)

UNIVERSITAS SYIAH KUALA

KANTOR : Jl. Syech Abdurra’uf Gedung Gelanggang Mahasiswa Lantai 1
Universitas Syiah Kuala, Darussalam, Banda Aceh
Email: uskkpr@gmail.com Telepon Selular +6282361007174/Call Center

FORMULIR PENDAFTARAN

CALON KETUA BADAN EKSEKUTIF MAHASISWA

UNIVERSITAS SYIAH KUALA
2022
1. Nama : ..........................................................................
2. Jenis Kelamin : Laki-laki/Perempuan *)coret yang tidak dperlukan
3. NIM : …...................................................................... Pas foto 3x4
(formal
4. Jurusan/Fakultas : .......................................................................... beralmamater,
5. Visi dan Misi : background
merah)
................................................................................................................
................................................................................................................
................................................................................................................
...........................................................................................................................
...........................................................................................................................
...........................................................................................................................
...........................................................................................................................
6. Motivasi mencalonkan diri :
...........................................................................................................................
...........................................................................................................................
...........................................................................................................................
...........................................................................................................................
7. Alamat E-mail : .....................................................................................
8. No Handphone : .....................................................................................
9. No. HP Dosen Wali : .....................................................................................
10. No. HP Wakil Dekan III : ..................................................................................

Banda Aceh, ...... Januari 2022

Ttd

Materai
10.000

(………………………..)
NIM.
 KOMISI PEMILIHAN RAYA (KPR)
UNIVERSITAS SYIAH KUALA
KANTOR : Jl. Syech Abdurra’uf Gedung Gelanggang Mahasiswa Lantai 1
Universitas Syiah Kuala, Darussalam, Banda Aceh
Email: uskkpr@gmail.com Telepon Selular +6282361007174/Call Center

FORMULIR PENDAFTARAN

CALON WAKIL KETUA BADAN EKSEKUTIF MAHASISWA

UNIVERSITAS SYIAH KUALA
2022
1. Nama : ..........................................................................
2. Jenis Kelamin : Laki-laki/Perempuan *)coret yang tidak dperlukan
3. NIM : …...................................................................... Pas foto 3x4
(formal
4. Jurusan/Fakultas : .......................................................................... beralmamater,
5. Visi dan Misi : background
merah)
................................................................................................................
................................................................................................................
................................................................................................................
...........................................................................................................................
...........................................................................................................................
...........................................................................................................................
...........................................................................................................................
6. Motivasi mencalonkan diri :
...........................................................................................................................
...........................................................................................................................
...........................................................................................................................
...........................................................................................................................
7. Alamat E-mail : .....................................................................................
8. No Handphone : .....................................................................................
9. No. HP Dosen Wali : .....................................................................................
10. No. HP Wakil Dekan III : ..................................................................................

Banda Aceh, ...... Januari 2022

Ttd

Materai
10.000

(………………………..)
NIM.