UNIVERSITAS PGRI PALEMBANG

FAKULTAS KEGURUAN DAN ILMU PENDIDIKAN

PROGRAM STUDI PENDIDIKAN JASMANI
Kampus B, Jl.PDAM Tirta musi bukit lama kec.ilir Barat 1 Palembang

FORMULIR PENDAFTARAN
BUJANG DAN GADIS PROGRAM STUDI PENDIDIKAN JASMANI

Nama Lengkap : …………………………………………….

Nama Panggilan : …………………………………………….
Angkatan : …………………………………………….
NIM : …………………………………………….
Tempat, Tanggal Lahir: …………………………………………….
Jenis Kelamin : ( Perempuan/Laki-Laki )*
Golongan Darah : ( A / B / O / AB )*
Alamat Asal : ................................................................................................................
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Alamat Kosan : ................................................................................................................
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No Handphone/WA : ................................................................................................................
Alamat Email : ................................................................................................................
Akun Sosial Media : ................................................................................................................
: ................................................................................................................
Hobi : ................................................................................................................
Keteranpilan :**
☐Video/photo editing ☐Public Speaking ☐Blogging/Menulis
☐Menari ☐Menyanyi ☐Olahraga…………….
☐Tilawah ☐Design ☐Manajemen Waktu
☐ Percaya Diri ☐ Networking ☐Beradaptasi
☐Kepemimpinan ☐Marketing ☐Perencanaa Acara
☐……………………………………………………………………………………………….
Deskripsikan Keterampilan : …………………………………………………………….
Anda …………………………………………………………….
*coret yang tidak perlu
**isi dengan tanda ✔