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PELATIHAN KADER DASAR TARUNA MELATI I (PKDTM I)

Pempinan Ranting Ikatan Pelajar Muhammadiyah SMA Muhammadiyah 4 Banjarnegara

CV . PESERTA

1. Nama : ....................................................................................................
2. Tempat tanggal lahir : ....................................................................................................
3. Alamat : ....................................................................................................
4. No.Telp / WA : ....................................................................................................
5. Sosial Media : ....................................................................................................
6. Nama Orang Tua
a. Ayah : ................................. , Pendidikan Terakhir :.............................
b. Ibu : ................................. , Pendidikan Terakhir :.............................
7. Riwayat Pendidikan
a. TK : ................................................................Lulus Tahun :.............
b. SD/MI : ................................................................Lulus Tahun :.............
c. SMP/MTs : ................................................................Lulus Tahun :.............
d. SMA/MA : ................................................................Lulus Tahun :.............
8. Riwayat Penyakit
…...............................................................................................................................................................
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9. Hobby
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10. Motto Hidup


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11. Harapan setelah mengikuti PKTM I


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Banjarnegara, ... Juli 2022

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