KOMISI PPEMILIHAN UMUM (KPU)

ORGANISASI SISWA INTRA SEKOLAH (OSIS)

SMA NEGERI 1 PAGELARAN
Jalan Raya Pagelaran Kp. Cibeureum Rt. 06/Rw. 07 Desa Sindangkerta
Kec. Pagelaran Kab. Cianjur 43266 Telp. (081573059508/081312702134)

FORMULIR PENDAFTARAN
PENGURUS MPK 2017/2018
Nama : ..........................................................
Tempat, Tanggal Lahir : ..........................................................
Alamat Rumah : ..........................................................
Kelas : ..........................................................
Nama Orang Tua : ..........................................................
Nomor Telepon. / HP : ..........................................................
Cita – Cita : ..........................................................
Motto Hidup : ..........................................................
Alamat
E MAIL : .........................................................
FACEBOOK : .........................................................
PENGALAMAN BERORGANISASI : .........................................................

PRESTASI
AKADEMIK : .........................................................
NON AKADEMIK : .........................................................
VISI : .........................................................
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MISI :
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JABATAN YANG DIINGINKAN :
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Cianjur ,........., Desember 2018

Calon Pengurus

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NIS. ..................

NB :
 (*) Bila mempunyai
 (**) Diisi tingkat tertinggi
 Foto 3x4 dan persyaratan lain diserahkan saat tes (tulis nama dibalik foto).