POLITEKNIK NEGERI SRIWIJAYA

HIMPUNAN MAHASISWA JURUSAN

MANAJEMEN INFORMATIKA
Jalan Srijaya Negara Bukit Besar Palembang 30319
Website: hmjmi.polsri.ac.id Email: hmjmiofficial.polsri@gmail.com
CP: 085171608350

FORMULIR PENDAFTARAN PENGURUS

HIMPUNAN MAHASISWA JURUSAN
MANAJEMEN INFORMATIKA
PERIODE 2024-2025

Nama : .........................................................................................................
Kelas : .....................................................................(Pagi/Sore/ Malam*)
Jenis Kelamin :.........................................................................................................
Tempat, Tanggal Lahir :.........................................................................................................
Agama :.........................................................................................................
Alamat Asal :.........................................................................................................
Alamat Kost :.........................................................................................................
No. Telp/Hp :.........................................................................................................

Riwayat Pendidikan Formal :

SD : ........................................................................................................................................
SMP : ........................................................................................................................................
SMA : ........................................................................................................................................

Pengalaman Organisasi :
1. ..............................................................................................................................................
2. ..............................................................................................................................................
3. ..............................................................................................................................................

Prestasi yang pernah diraih :

1. ..............................................................................................................................................
2. ..............................................................................................................................................
3. ..............................................................................................................................................

Visi dan Misi bergabung dalam HMJ Manajemen Informatika :

a. Visi :
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b. Misi :
1. .........................................................................................................................................
2. .........................................................................................................................................
3. .........................................................................................................................................

Palembang, 2023
Pelamar
Foto
3x4

*coret yang tidak perlu ( )

 POLITEKNIK NEGERI SRIWIJAYA
HIMPUNAN MAHASISWA JURUSAN
MANAJEMEN INFORMATIKA
Jalan Srijaya Negara Bukit Besar Palembang 30319
Website: hmjmi.polsri.ac.id Email: hmjmiofficial.polsri@gmail.com
CP: 085171608350

Pengetahuan Seputar HMJ :

✓ Apa yang anda ketahui tentang HMJ MI ?
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✓ Skill apa yang anda miliki untuk mendukung kinerja HMJ MI ?

1. ………………………….
2. ………………………….
3. ………………………….
4. ………………………….

✓ Bakat apa yang anda miliki untuk mendukung kinerja HMJ MI?
1. …………………………
2. …………………………
3. …………………………
4. …………………………

✓ Jika kalian terpilih menjadi salah satu anggota HMJ MI :

a. Pada divisi apa kalian ingin ditempatkan ? *pilih salah satu (PTKP, HUMAS,
PSDM, KESMA, BISTRA)
Alasan :
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b. Jika Anda terpilih, kontribusi apa yang akan anda berikan, terutama pada divisi
yang anda pilih?
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