FORMULIR
PENDAFTARAN CALON ANAK SANGGAR SENI
PUTROE STMIK
Nama
Lengkap :
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Nama Panggilan :......................................................................
Jurusan :......................................................................
Nim :......................................................................
Tempat Tanggal Lahir :......................................................................
Jenis Kelamin :......................................................................
Alamat Asal :......................................................................
Alamat Sekarang :......................................................................
Nomor Hp & Pin BBM :......................................................................
Email :......................................................................
Facebook :......................................................................
Twiter :......................................................................
Blog :......................................................................
Cita – cita :......................................................................
Hobi : .....................................................................
Aktivitas selain
sekolah
: .....................................................................
Kriteria
Tempat TinggalLaju (Rumah Orang Tua)/Kost/Pondok
Tempat Kost/Pondok :.....................................................................
Potensi seni yang dimiliki :
....................................................................
Prestasi yang pernah dicapaI :.....................................................................
Kegiatan Ekstra
Kurikuler :.....................................................................
Kebiasaan baik yang dilakukan :.....................................................................
Kebiasaan buruk yang dilakukan :.....................................................................
Pengalaman dibidang seni :.....................................................................
......................................................................
Bidang seni yang dipilih :.....................................................................
Alasan masuk Sanggar seni :.....................................................................
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Banda Aceh, , …. …………. 2012
(…………………………)
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