No.

: 207

PANITIA PELAKSANA OPEN RECRUITMENT

DAN LEADERSHIP TRAINING
UNIT KEGIATAN MAHASISWA (UKM) BAHASA
POLITEKNIK NEGERI UJUNG PANDANG
Sekretariat: PKM Politeknik Negeri Ujung Pandang
Jln. Perintis Kemerdekaan Km. 10 Tamalanrea Makassar 90245
Telp: 081 234 540 308 Email: pnupukmbahasa@gmail.com

REGISTRATION FORM

FULL NAME : VERA PRAWESTI

NICK NAME : VERA / VEVEY
LEDGER (STAMBUK) : 45220009
DEPARTEMENT : BUSSINES ADMINISTRASION
PLACE AND DATE OF BIRTH : TASIKMALAYA, 28 SEPTEMBER 2002
SEX : FEMALE
RELIGION : ISLAM / MOSLEM
PHONE NUMBER : 0895364591536
HOBBY : PLAYING BASKETBALL, SWIMMING, AND PHOTO.
ADDRESS IN MAKASSAR : JL. WALISONGO LR. SEHATI NO.14, MAKASSAR
REGIONAL FROM : TASIKMALAYA
SCHOOL ORIGION : SMK NEGERI 4 MAKASSAR
EDUCATION BACKGROUND :
1. KINDER GARDEN “MURNI”
2. ELEMENTARY SCHOOL PONGTIKU 1 MAKASSAR
3. JUNIOR HIGH SCHOOL NEGERI 4 MAKASSAR
4. VOCATIONAL SCHOOL NEGERI 4 MAKASSAR
ORGANIZATION EXPERIENCE:
1. OSIS MEMBERS SMK N 4 MAKASSAR
2. …………………………………………………………………………………………………..…
3. …………………………………………………………………………………………………..…
LINGUISTIC ACTIVITIES HAVE BEEN FOLLOWED :
TRAINING : …………………………………………………………………….……………………………………………

COURSE : ENGLISH, MANDARIN, JAPAN, KOREA, ARAB, ……….……………………………………………

CONTEST : …………………………………………………………………….……………………………………………

MAKASSAR, 29 MARCH 2021

Nb :
 Use English and capital letters
 Register form must be typed using times new roman font 11 and convert to pdf
 Returning form fee is Rp. 15.000,-
 Returning form period end on March 28th , 2021
 For more information, contact us via WA 081 234 540 308, http://ukmbahasa.poliupg.ac.id
or in Secretariat of UKM Bahasa Politeknik Negeri Ujung Pandang