FORMULIR KKN/KKS STAI MA'ARIF METRO LAMPUNG

PANITIA PELAKSANA KULIAH KERJA SOSIAL (KKS)

SEKOLAH TINGGI AGAMA ISLAM (STAI) MA’ARIF

METRO LAMPUNG

TAHUN 2012

 

Alamat: Jl. RA. Kartini  28 Purwosari, Tlp. (0725) 7851430 Kec. Metro Utara Kota Metro

 

FORMULIR PENDAFTARAN

Nama                                             :    ...........................................................................................

NPM                                              :    ...........................................................................................

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

Jurusan                                          :    ...........................................................................................

Program Studi                               :    ...........................................................................................

Semester                                        :    ...........................................................................................

Alamat                                           :    ...........................................................................................

Nomor Telepon/HP                       :    ...........................................................................................

Status                                            :           Menikah                           Belum Menikah

Pekerjaan                                       :           PNS                                  Non PNS

Instansi Tempat Bekerja                :    ...........................................................................................

Keahlian/Keterampilan Khusus     :    ...........................................................................................

Metro, ……………………

Pendaftar

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