FORMULIR PENDAFTARAN PANITIA OSPEK FAKULTAS TEKNIK UNY TAHUN 2012 Nama Lengkap Nama Panggilan Tempat, Tanggal lahir Alamat asal Alamat di Yogyakarta Agama/ Gol. Darah Jurusan/Prodi NIM IPK Email Hobbi Motto Cita-cita No. Telp/ HP Delegasi : : : : : : : : : : : : : : : .............................................................................................................. .............................................................................................................. .............................................................................................................. Foto 3 x 4 .............................................................................................................. .............................................................................................................. .............................................................................................................. .............................................................................................................. .............................................................................................................. .............................................................................................................. .............................................................................................................. .............................................................................................................. .............................................................................................................. .............................................................................................................. .............................................................................................................. ..............................................................................................................

Riwayat Pendidikan : No Pendidikan 1 2 3 4 Riwayat Pelatihan / Training Kursus: No Nama Lembaga 1 2 3 4 Organisasi yang Pernah Diikuti : No Nama Organisasi 1 2 3 4

Tempat

Tahun Lulus

Alamat

Tahun

Jabatan

Periode

Keahlian yang dimiliki (diberi Centang) :Bela Diri Tae Kwondo Karate Kungfu Silat Tinju Mengemudi Mobil Motor Olah Raga Bulu Tangkis Volley Sepak Bola Tenis Lapangan Tenis Meja Menulis Karya Tulis Ilmiah Non Fiksi Terjemahan Novel Puisi Seni Kaligrafi Musik Tari Lukis Fotografi Teknik Listrik Elektronika Jaringan Internet Otomotif Memasak Menjahit Internet Mengelola Website Mengelola Blog

Bahasa Asing & Daerah Inggris Arab Jepang Mandarin Jawa Sunda

Komunikasi Retorika Public Relation Wacana Improvisasi Humas

Pilihan KepanitianKorfak Sekretaris Bendahara Keadministrasian Acara Perlengkapan P3K Kepanitiaan Data Konsumsi PDD Keamanan Humas Sponsorship Pemandu Kreativitas Pengembangan Sumber Daya Pemandu (PSDP) Operasional Kajian dan Riset

Alasannya! ...................................................................................................................................................... ...................................................................................................................................................... Motivasi dan Misi mengikuti Kepanitian OSPEK! ...................................................................................................................................................... ...................................................................................................................................................... Yogyakarta, ..................................... 2012

( ________________________ ) NIM.