NAMA LENGKAP : ............................................................................................................. NAMA LENGKAP : .............................................................................................................
TEMPAT / TGL. LAHIR : ............................................................................................................. TEMPAT / TGL. LAHIR : ............................................................................................................. KELAS : ............................................................................................................. KELAS : ............................................................................................................. NO. TELP. / HP. : ............................................................................................................. NO. TELP. / HP. : ............................................................................................................. PENGALAMAN BERORGANISASI : PENGALAMAN BERORGANISASI : 1. ................................................................................................................................................. 1. ................................................................................................................................................. 2. ................................................................................................................................................. 2. ................................................................................................................................................. PRESTASI YANG PERNAH DIRAIH : PRESTASI YANG PERNAH DIRAIH : AKADEMIK : ............................................................................................................. AKADEMIK : ............................................................................................................. NON AKADEMIK : ............................................................................................................. NON AKADEMIK : ............................................................................................................. ALASAN INGIN MASUK OSIS : ALASAN INGIN MASUK OSIS : ....................................................................................................................................................... ....................................................................................................................................................... ....................................................................................................................................................... ....................................................................................................................................................... JABATAN YANG DIINGINKAN : .................................................................................................. JABATAN YANG DIINGINKAN : ..................................................................................................
Bogor, ............................................... 2016 Bogor, ............................................... 2016