ORGANISASI SISWA INTRA SEKOLAH ( OSIS )

MAJELIS PERWAKILAN KELAS ( MPK )

SMA NEGERI 2 PUTUSSIBAU SELATAN
Jl. Tani 2 - putussibau selatan 78714
FORMULIR PENDAFTARAN CALON
ANGGOTA PENGURUS OSIS DAN MPK

IDENTITAS DIRI
Nama Lengkap :..............................................................
Nama panggilan :..............................................................
Kelas :..............................................................
Tempat, Tanggal Lahir :..............................................................
Alamat Tempat Tinggal :..............................................................
Nomor Handphone :..............................................................
Nama Orang Tua :..............................................................
Cita-cita :..............................................................
Hobi :..............................................................
Motto Hidup :..............................................................
Jabatan yang di inginkan :..............................................................

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Dengan mengisi Formulir Pendaftaran Pengurus OSIS ini, maka saya secara sadar dan
tanpa paksaan dari pihak manapun, serta atas sepengetahuan dan izin dari orang tua
/wali murid untuk mengikuti Pendaftaran Pengurus OSIS
 KETUA OSIS

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