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KEMENTERIAN PENDIDIKAN, KEBUDAYAAN,

RISET, DAN TEKNOLOGI


UNIVERSITAS MATARAM
FAKULTAS KEGURUAN DAN ILMU PENDIDIKAN
HIMPUNAN MAHASISWA PROGRAM STUDI PENDIDIKAN MATEMATIKA
Jln. Majapahit No. 62 Mataram 83125, CP : 085962758650

FORMULIR PENDAFTARAN PENGURUS BARU


HIMATIKA FKIP UNRAM PERIODE 2023

1. Nama : _________________________________________________________

2. NIM : __________________________________________________________

3. Kelas : _________________________________________________________

4. TTL : __________________________________________________________

5. No HP/WA : ____________________________________________________

6. Semester : ______________________________________________________

7. Alamat Asal : ___________________________________________________

8. Alamat Domisili (Sekarang) : ______________________________________

9. Alasan Masuk Himatika : __________________________________________

10. Pilihan Departemen 1 : ____________________________________________

11. Alasan : ________________________________________________________


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12. Pilihan Departemen 2 : ____________________________________________

13. Alasan : ________________________________________________________


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14. Apa hal yang akan kalian lakukan jika diterima di himatika : ______________
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