Nama : ...............................................................................................
Alamat : ...............................................................................................
...............................................................................................
Telp. / HP : ..................................... / ...........................................
Nama : .....................................................................................................
Tempat, tgl lahir : .....................................................................................................
Jenis kelamin : .....................................................................................................
Agama : .....................................................................................................
Kelas:
Ekstrakurikuler : ....................................................................................................
Alamat : ....................................................................................................
.....................................................................................................
Dengan ini memberikan izin kepada anak saya untuk dapat mencalonkan diri dalam jajaran
kepengurusan Organisasi Siswa Intra Sekolah (OSIS) SMK 11 MARET Cikarang Periode /
Masa Jabatan 2021 – 2022.
(.........................................)