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UNIT KEGIATAN MAHASISWA

SHIPBUILDING POLYTECHNIC ENGLISH DEVELOPMENT SOCIETY
(POCEDS)
POLITEKNIK PERKAPALAN NEGERI SURABAYA
Sekretariat : Jl. Teknik Kimia Kampus PPNS ITS Sukolilo- Surabaya Jawa Timur 60111
Telp. (fax) (031) 5942887 website www.ppns.ac.id

REGISTRATION FORM
Full Name
Nick Name
Birth Place & Date
Gender
NRP
Home Address
Boarding Home Address
Phone Number
Email

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Photo
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3x4
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FORMAL
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Organizational Experiences :
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Organizational Activities (other organization outside POCEDS that you are following
now) :
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Special Skills (you can choose more than one)
Microsoft (Excell, Publisher, etc.)

Cinematography

Graphic Design

Car Driver (SIM A)

Photography

Others

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UNIT KEGIATAN MAHASISWA
SHIPBUILDING POLYTECHNIC ENGLISH DEVELOPMENT SOCIETY
(POCEDS)
POLITEKNIK PERKAPALAN NEGERI SURABAYA
Sekretariat : Jl. Teknik Kimia Kampus PPNS ITS Sukolilo- Surabaya Jawa Timur 60111
Telp. (fax) (031) 5942887 website www.ppns.ac.id

Motivation :
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Motto :
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Interests :
Debate

News Casting

Speech

Essay Writting

Story Telling
Ranks :
Athlete
Member
Board Member

Surabaya,

September 2016

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