STEM English Club

Sekolah Tinggi Energi Dan Mineral

CLUB MEMBERSHIP APPLICATION 2015-2016

Photo

1. Identity
3x4
a. Name
:..............................................................................
b. Major
: .............................................................................
c. Room
: .............................................................................
d. Date of birth
: .............................................................................
2. Personal interest: music/culture/politic/social/education/.
3. Level scale of English ability (skala tingkat kemampuan berbahasa
inggris: pilih salah satu)
Beginner :I do not speak any English
Elementary
:I can say and understand a few things in English
Intermediate :I understand English well but I cant speak fluently
Advance :I understand well and speak fluently but sometimes
have problem in Grammar and vocabularies
4. Percentages of interest in joining SEC (prosentase minat keikutsertaan
dalam SEC:pilih salah satu)
20%
60%
100
40%
5. Experience/achievements
in English80%
(pengalaman/prestasi
berbahasa
Inggris)
a.
b.
6. What is your motivation to join SEC? (motivasi bergabung dalam SEC)

7. Are you willing to participate in every activities of SEC 2015/2016?

(apakah Anda bersedia ikut serta dalam setiap aktivitas SEC selama
tahun akademik 2015/2016?)
NO
YES
Cepu,
August 2015
Participant,