SURAT IZIN ORANG TUA/WALI

Yang bertanda tangan dibawah ini :

Nama : .............................................................
Alamat : ...............................................................................................
...............................................................................................
Telp /
HP..................................... / ...........................................

Selaku orang tua dari anak saya :

Nama : ....................................................
Tempat, tgl lahir
: ......................................................................................
Jenis kelamin
: ......................................................................................
Agama
: ......................................................................................
Kelas : .....................................................................................
.
Nisn
: ......................................................................................
Alamat : .....................................................................................
.
.....................................................................................
.

Dengan ini memberikan izin kepada anak saya untuk dapat

mencalonkan diri dalam jajaran kepengurusan Organisasi Siswa Intra
Sekolah (OSIS) SMA NEGERI 6 Rejang Lebong Periode / Masa
Jabatan 2023– 2024.

Demikian surat ini kami buat untuk dipergunakan sebagaimana

mestinya.
 Rejang Lebong, Oktober 2023
Orang Tua/Wali

(.........................................)

SURAT PERNYATAAN KESANGGUPAN

Yang bertanda tangan dibawah ini :

Nama : ....................................................
Tempat, tgl lahir
: ......................................................................................
Jenis kelamin
: ......................................................................................
Agama
: ......................................................................................
Kelas : .....................................................................................
.
Nisn : .....................................................................................
.
Alamat : .....................................................................................
.
.....................................................................................
.

Dengan ini menyatakan bersedia menjadi Calon Pengurus Organisasi

Siswa Intra Sekolah (OSIS) SMA Negeri 6 Rejang Lebong Periode /
Masa Jabatan 2023 – 2024 mematuhi segala prosedur dan peraturan
sebagai calon pengurus OSIS SMA Negeri 6 Rejang Lebong.

Demikian surat pernyataan kesanggupan ini dibuat dengan

sesungguhnya tanpa paksaan dari pihak manapun.

Mengetahui Rejang Lebong, Oktober 2023

Orang Tua/Wali Yang Membuat Pernyataan

(.........................................) (.........................................)

BIODATA
CALON PENGURUS OSIS
Periode 2023 - 2024

Nama
: ......................................................................................
Nama Panggilan
: ......................................................................................
Tempat, tgl lahir
: ......................................................................................
Jenis kelamin
: ......................................................................................
Agama
: ......................................................................................
Kelas/Wali Kelas
: ............................ / .......................................................
Hoby : .....................................................................................
.
Cita-Cita
: ......................................................................................
Ekstrakurikuler : .....................................................................................
.
Nama Ayah
: ......................................................................................
Nama Ibu
: ......................................................................................
Alamat : .....................................................................................
.
.....................................................................................
.
Telp /
HP ......................................................................

Visi & Misi :

Visi : 1. ....................................................................................................
2. ....................................................................................................
3. ....................................................................................................

Misi : 1. ....................................................................................................
2. ....................................................................................................
3. ....................................................................................................

Mengetahui Rejang Lebong, Oktober 2023

Orang Tua/Wali Ttd Calon Pengurus OSIS

(.........................................) (.........................................)