PUSAT HUMAS UNIVERSITAS SANATA DHARMA Petugas... · Web viewPengalaman berorganisasi/kegiatan di...

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Terakreditasi A, SK BAN-PT No: 2993/SK/BAN-PT/Akred/PT/XII/2016 Jalan Affandi, Mrican, Caturtunggal, Depok, Sleman, Yogyakarta 55281 Formulir Pendaftaran Petugas PMB & Promosi USD T.A. 2019/2020 1. Nama Lengkap : ___________________________________________________________ 2. Nama Panggilan : ___________________________________________________________ 3. Program Studi : ___________________________________________________________ 4. Nomor Mahasiswa : ___________________________________________________________ 5. SKS yang telah ditempuh : ___________________________________________________________ 6. IPK : ___________________________________________________________ 7. Tempat, Tanggal Lahir : ___________________________________________________________ 8. Jenis Kelamin : ___________________________________________________________ 9. Agama : ___________________________________________________________ 10. Alamat Asal : ___________________________________________________________ 11. Alamat Kos : ___________________________________________________________ 12. Nomor HP/WA : ___________________________________________________________ 13. E-mail : ___________________________________________________________ 14. Motivasi Mendaftar : ___________________________________________________________ 15. Pengalaman berorganisasi/kegiatan di kampus : ____________________________________________ ___________________________________________________________________________________ 16. Pengalaman berorganisasi/kegiatan di luar kampus : ________________________________________ ___________________________________________________________________________________ 17. Pengalaman Kerja : ________ ___________________________________________________________ ___________________________________________________________________________________ 18. Program-program komputer yang dikuasai : _______________________________________________ ___________________________________________________________________________________ 19. Keahlian khusus/keistimewaan yang dimiliki : ______________________________________________ ___________________________________________________________________________________ 20. Asal Sekolah Nama : ___________________________________________________________________________ Alamat : ___________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ Yogyakarta, ____________________

Transcript of PUSAT HUMAS UNIVERSITAS SANATA DHARMA Petugas... · Web viewPengalaman berorganisasi/kegiatan di...

Terakreditasi A, SK BAN-PT No: 2993/SK/BAN-PT/Akred/PT/XII/2016Jalan Affandi, Mrican, Caturtunggal, Depok, Sleman, Yogyakarta 55281

Formulir PendaftaranPetugas PMB & Promosi USD T.A. 2019/2020

1. Nama Lengkap : ___________________________________________________________2. Nama Panggilan : ___________________________________________________________3. Program Studi : ___________________________________________________________4. Nomor Mahasiswa : ___________________________________________________________5. SKS yang telah ditempuh : ___________________________________________________________6. IPK : ___________________________________________________________7. Tempat, Tanggal Lahir : ___________________________________________________________8. Jenis Kelamin : ___________________________________________________________9. Agama : ___________________________________________________________10. Alamat Asal : ___________________________________________________________11. Alamat Kos : ___________________________________________________________12. Nomor HP/WA : ___________________________________________________________ 13. E-mail : ___________________________________________________________ 14. Motivasi Mendaftar : ___________________________________________________________15. Pengalaman berorganisasi/kegiatan di kampus : ____________________________________________

___________________________________________________________________________________16. Pengalaman berorganisasi/kegiatan di luar kampus : ________________________________________

___________________________________________________________________________________17. Pengalaman Kerja : ________ ___________________________________________________________

___________________________________________________________________________________18. Program-program komputer yang dikuasai : _______________________________________________

___________________________________________________________________________________19. Keahlian khusus/keistimewaan yang dimiliki : ______________________________________________

___________________________________________________________________________________20. Asal Sekolah

Nama : ___________________________________________________________________________Alamat : _________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Yogyakarta, ____________________

______________________________Tanda Tangan & Nama Lengkap