PENGURUS CABANG NAHDLATUL ULAMA

KABUPATEN MESUJI PROVINSI LAMPUNG

Jl. Pangeran Mat Ali Brabasan Tanjung Raya, Mesuji Hp. 0811797768 / 085380272726

PERSYARATAN PESERTA
PENDIDIKAN KADER PENGGERAK NAHDLATUL ULAMA
ANGKATAN X PCNU KAB. MESUJI TAHUN 2022

1. Mengisi Formulir Kesediaan Mejadi Peserta dan Identitas Diri.

2. Mendapat Rekomendasi dari MWC NU/Ranting NU/BANOM / dan PCNU (untuk peserta
dari luar Mesuji )
3. Membayar biaya pendaftran Rp. 250.000,-(Duaratus limapuluh Ribu Rupiah)
4. Membawa perlengkapan 3 stel :
a. Siang Hari : Kemeja Putih, Celana Gelap dan Peci Songkok (laki-laki)
Baju putih, rok hitam dan kerudung hitam (perempuan)
b. Malam Hari : Koko Putih, Sarung Hitam dan Peci Songkok(laki-laki)
Baju putih, rok / sarung warna gelap dan jilbab hitam(perempuan)
c. Pakaian Olah Raga : Kaos, Training,
d. Alat mandi pribadi
e. Membawa perlengkapan protokol kesehatan masing masing
f. Bagi laki-laki membawa satu songkok hitam baru dan bagi perempuan membawa satu
kerudung hitam baru untuk persayaratan baiat.
5. Siap Menjalankan Komitmen dan Tugas sebagai Kader Penggerak NU.
6. membawa masker kain pribadi masing-masing orang minimal 3
 PENGURUS CABANG NAHDLATUL ULAMA
KABUPATEN MESUJI PROVINSI LAMPUNG
Jl. Pangeran Mat Ali Brabasan Tanjung Raya, Mesuji Hp. 0811797768 / 085380272726

FORMULIR KESEDIAAN CALON PESERTA

PENDIDIKAN KADER PENGGERAK (PKP) NU ANGKATAN X
PENGURUS CABANG NAHDLATUL ULAMA KAB. MESUJI
TAHUN 2022

Yang bertanda tangan di bawah ini :

Nama : ………………………………………….
Tempat Tanggal Lahir : ………………………………………….
Utusan : (Ranting/MWC/PAC)……….…………

Menyatakan dengan sungguh-sungguh :

1. Akan mengikuti seluruh rangkaian acara dari awal hingga akhir Pendidikan Kader
Penggerak Nahdlatul Ulama yang diselenggarakan oleh Pengurus Cabang Nahdlatul Ulama
Kab. Mesuji.
2. Akan mengikuti seluruh aturan yang telah ditetapkan oleh panitia demi kelangsungan dan
kesuksesan acara tersebut.
3. Akan menjalankan seluruh pengetahuan dan ilmu yang didapatkan dalam kaderisasi tersebut
dalam rangka membesarkan organisasi Nahdlatul Ulama dan mempertahankan paham
ahlussunah wal jamaah di bumi nusantara.
4. Akan mempertahankan dan mencegah dari berbagai ancaman dan upaya untuk
menghancurkan NU dan paham Ahlus Sunnah Waljama’ah.
5. Tidak akan melakukan tindakan yang bertentangan dengan garis besar perjuangan Nahdatul
Ulama.

Demikian pernyataan ini kami nyatakan dengan sebenar-benarnya demi hikmah kepada
Nahdhatul Ulama dan perjuangan para ulama.

..............................., ..... /.... /2022

Disetujui/Direkomendasikan Oleh Calon Peserta

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 PENGURUS CABANG NAHDLATUL ULAMA
KABUPATEN MESUJI PROVINSI LAMPUNG
Jl. Pangeran Mat Ali Brabasan Tanjung Raya, Mesuji Hp. 0811797768 / 085380272726

FORMULIR IDENTITAS CALON PESERTA

PENDIDIKAN KADER PENGGERAK (PKP) NU ANGKATAN X
PENGURUS CABANG NAHDLATUL ULAMA KABUPATEN MESUJI

A. Identitas Diri

1. Nama : ..........................................................................................................
2. Jenis Kelamin : ..........................................................................................................
3. Tempat/Tgl Lahir : ..........................................................................................................
4. Alamat Rumah : ..........................................................................................................
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5. Telpon, HP dan email :
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6. Jabatan di NU Wilayah/Cabang /Ranting/Lembaga/Banom :
................................................................................................................................................
7. Lama jabatan:
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B. Pendidikan

1. Pendidikan Terakhir:
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2. Pendidikan Informal/Pengalaman Pendidikan Yang Pernah Diikuti

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3. Riwayat Hidup (silahkan menuliskan dalam kertas tersendiri)

4. Bagaimana pendidikan kader penggerak akan mendukung kerja-kerja penguatan NU dilevel struktur
maupun kultur diCabang, MWC atau Ranting?
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 PENGURUS CABANG NAHDLATUL ULAMA
KABUPATEN MESUJI PROVINSI LAMPUNG
Jl. Pangeran Mat Ali Brabasan Tanjung Raya, Mesuji Hp. 0811797768 / 085380272726

C. Pengalaman Berorganisasi

1. Organisasi Siswa :
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2. Organisasi Santri/Kealumnian :
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3. Organisasi Mahasiswa :
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4. Organisasi Kepemudaan :
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D. Pengalaman Mengorganisasi Kegiatan

1. Pengalaman mengorganisasi NU struktural :

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..............................., ..... /.... /2022

Calon Peserta

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