KEMENTERIAN PENDIDIKAN, KEBUDAYAAN,

RISET DAN TEKNOLOGI

UNIVERSITAS NEGERI SURABAYA
FAKULTAS EKONOMIKA DAN BISNIS
JURUSAN PENDIDIKAN EKONOMI
HIMPUNAN MAHASISWA
Kampus Ketintang, Jalan Ketintang, Surabaya 60231
Telepon : +6231 - 8285362, Faksimil : +6231 - 8293416
Laman : https://feb.unesa.ac.id email : feb@unesa.ac.id

FORMULIR PENDAFTARAN
“JPE MENGABDI VIII ”
2021

Yang bertanda tangan dibawah ini:

1. Nama : .......................................................................................
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2. Kelas dan Prodi :

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3. NIM :
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4. Tempat, Tanggal Lahir :
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5. Jenis Kelamin :
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6. Agama : .......................................................................................
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7. Alamat Sekarang :
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8. No. HP/ WA :
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9. Pengalaman Kegiatan Sosial :

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 KEMENTERIAN PENDIDIKAN, KEBUDAYAAN,
RISET DAN TEKNOLOGI
UNIVERSITAS NEGERI SURABAYA
FAKULTAS EKONOMIKA DAN BISNIS
JURUSAN PENDIDIKAN EKONOMI
HIMPUNAN MAHASISWA
Kampus Ketintang, Jalan Ketintang, Surabaya 60231
Telepon : +6231 - 8285362, Faksimil : +6231 - 8293416
Laman : https://feb.unesa.ac.id email : feb@unesa.ac.id

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10. Motto Hidup :

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11. Kelebihan yang Dimiliki :

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12. Kekurangan yang Dimiliki :

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13. Hobi :

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Dengan ini saya menyatakan bahwa formulir diisi dengan yang sebenar-benarnya dan
siap menerima konsekuensi apabila terdapat ketidaksetiaan.

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Foto
4X6

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