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Transcript of Web viewSEKSI MAHASISWA IKATAN AHLI GEOLOGI INDONESIA. SEKOLAH TINGGI TEKNOLOGI NASIONAL (SM IAGI ....
SEKSI MAHASISWA IKATAN AHLI GEOLOGI INDONESIA
SEKOLAH TINGGI TEKNOLOGI NASIONAL
(SM IAGI STTNAS)
Sekertariat : Gedung A Lantai 1 Kampus STTNAS Yogyakarta
Jalan Babarsari, Caturtunggal Depok, Sleman, D.I Yogyakarta
Kode Pos 55281, Telp : 0899 1715 747, E-mail : [email protected]
FORMULIR PENDAFTARAN
Curriculum Vitae
Nama Lengkap : .....................................................
NIM / Angkatan : ................................./...................
Pas foto
3 X 4
(Foto Resmi dan Rapi)
IPK terakhir : .....................................................
Tempat, Tanggal Lahir : .....................................................
Alamat : .....................................................
.....................................................
.....................................................
Kode Pos : .....................................................
Jenis Kelamin : .....................................................
Agama : .....................................................
Status pernikahan : .....................................................
Telephone/ hp : .....................................................
E-Mail : .....................................................
Divisi / Departement yang dipilih di SM-IAGI STTNAS : ........................................
(Pilih salah satu)
1) KEILMUAN
2) PSDM (Pengembangan Sumberdaya Mahasiswa)
3) SOSMAS (Sosial Masyarakat)
4) INFOKOM (Informasi dan Komunikasi)
Orang tua :
Ayah : ....................................................................
Umur : ....................................................................
Pekerjaan : ....................................................................
Alamat : .................................................................... ....................................................................
Ibu : ....................................................................
Umur : ....................................................................
Pekerjaan : ....................................................................
Alamat : .................................................................... ....................................................................
Riwayat Pendidikan :
SD : ...............................................
Tahun ....... - ........
SMP / Sederajat : ...............................................
Tahun ....... - ........
SMA / Sederajat : ...............................................
Tahun ....... - ........
Sekolah Tinggi Teknologi Nasional (STTNAS) Yogyakarta
Tahun ....... - Sekarang
Pengalaman Organisasi :
Tahun ....... ........: ...................................................................................................
Tahun ....... ........: ...................................................................................................
Tahun ....... ........: ...................................................................................................
Apa motivasi kamu, dan seberapa besar niat serta komitment kamu untuk menjadi Pengurus SM-IAGI STTNAS Yogyakarta ?
..................................................................................................................................................................................................................................................................................................................................................................................................................................................................... ....................................................................................................................................................... ....................................................................................................................................................... .......................................................................................................................................................
ESSAY KEILMUAN
Tema Potensi Unconventional Energi di Indonesia
(Minimal 2 lembar, boleh di ketik atau di tulis tangan, tanpa gambar) ....................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................
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