FORMULIR PENDAFTARAN PENERIMAAN ANGGOTA OSIS BARU

Posted By gusdar »

Jumat, 23 Maret 2018

SEKRETARIAT PAOB

PENERIMAAN ANGGOTA OSIS BARU

MAN 1 NGAWI Periode jabatan  2018 - 2019

Jl. Jekitut No.688A, Beran Ngawi

Instagram : Osis Man Ngawi

                                                                       

No.Pendaftaran : ..............................

FORMULIR PENDAFTARAN

PENERIMAAN ANGGOTA OSIS BARU

MADRASAH ALIYAH NEGERI 1 NGAWI PERIODE JABATAN 2018 – 2019

Nama Lengkap / Panggilan         :  ........................................................ /....................................

Tempat Tanggal Lahir                :  ..............................................................................................

Kelas                                         :  ..............................................................................................

Jenis Kelamin                            :  Laki – laki / Perempuan

Agama                                       :  ..............................................................................................

Alamat Asli                                :  ..............................................................................................

                                                    ..............................................................................................

Alamat Sementara / Kos             :  ..............................................................................................

                                                    ..............................................................................................

Telepon Rumah / Hp  ( WA )      :  ..............................................................................................

Facebook /E-mail                       :  ..............................................................................................

Visi                                            :  ..............................................................................................

                                                    ..............................................................................................

Misi                                           :  ..............................................................................................

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Pas Foto 3 x 4

                                                                 

                                                                                              Ngawi, ............................... 2017

                                                                                                

                                                                                                  ____________________

                                                                                                  (                                       )

SURAT IZIN ORANG TUA

Yang bertanda tangan di bawah ini :

Nama           : .........................................................................................
Alamat         : .........................................................................................

Selaku Orang tua dari

Nama                               :    ..............................................................................................
Tempat/Tgl. Lahir           :    ..............................................................................................
Jenis Kelamin                  :    ..............................................................................................
Alamat                             :    ..............................................................................................
Agama                             :    ..............................................................................................
Asal Sekolah/Kelas         :    ..............................................................................................

Dengan ini memberikan  izin dan mendukung anak saya untuk mengikuti   “ PENERIMAAN ANGGOTA OSIS BARU MASA PERIODE JABATAN 2018 – 2019 ”. Demikian surat izin ini kami buat untuk dipergunakan sebagaimana mestinya.

                                                                                   Ngawi, _________________ 2017

                                                                                                       Orang tua,

                                                                                       .............................................

                                                                                         (                                       )

                                                                                                                                                     

 SURAT PERNYATAAN

Yang bertanda tangan dibawah ini, saya :

Nama           : .........................................................................................
Alamat         : .........................................................................................

Selaku Orang tua dari

Nama                               :    ..............................................................................................
Tempat/Tgl. Lahir           :    ..............................................................................................
Jenis Kelamin                  :    ..............................................................................................
Alamat                             :    ..............................................................................................
Agama                             :    ..............................................................................................
Asal Sekolah/Kelas         :    ..............................................................................................

Dengan ini menyatakan bahwa saya menyerahkan  hak penuh anak saya kepada senior OSIS MAN 1 Ngawi masa jabatan 2017 – 2018 untuk mendidik dan mmbimbing anak saya agar menjadi pengurus dan anggota OSIS selanjutnya. Dan saya menerima anak saya diberi sanksi jika dia melanggar aturan yang telah disepakati di OSIS.

Demikianlah surat pernyataan ini disampaikan untuk dapat dipergunakan sebagaimana mesinya.

                                                                                   Ngawi, _________________ 2017

                                                                                                       Orang tua,

	MATERAI 6000

 

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