Form Pendaftaran TeSA
REPUBLIK MAHASISWA
UNIVERSITAS ISLAM NEGERI MAULANA MALIK IBRAHIM MALANG
LSO PEER COUNSELING OASIS
DEWAN MAHASISWA FAKULTAS PSIKOLOGI
PERIODE 2013
Sekretariat :Gedung Student Center Lt 1, Jl Gajayana No 50 Malang
Telp: 085736918029
FORM PENDAFTARAN
RELAWAN TeSA (Telepon Sahabat Anak)
Nama
: ............................................................................
NIM
: ............................................................................
Fak/Jurusan
: ............................................................................
Angkatan (Semester)
: ............................................................................
IPK
: ............................................................................
No HP
: ............................................................................
Alamat di Malang
: ............................................................................
............................................................................
Kegiatan sehari-hari
: a. ........................................................................
b. ........................................................................
c. ........................................................................
d. ........................................................................
e. ........................................................................
Alasan Mendaftar Sebagai Relawan TeSA?
...................................................................................................
...................................................................................................
...................................................................................................
...................................................................................................
........................................................................
Dengan ini saya yang beridentitas di atas menyatakan bahwa:
1. BERSEDIA mengikuti kegiatan yang telah diagendakan.
2. Menerima hasil keputusan penetapan peserta dari panitia.
Malang, …… Desember 2013
Nama:
_____________________________
Publish by. http://psikologi.uin-malang.ac.id
REPUBLIK MAHASISWA
UNIVERSITAS ISLAM NEGERI MAULANA MALIK IBRAHIM MALANG
LSO PEER COUNSELING OASIS
DEWAN MAHASISWA FAKULTAS PSIKOLOGI
PERIODE 2013
Sekretariat :Gedung Student Center Lt 1, Jl Gajayana No 50 Malang
Telp: 085736918029
NIM:
_______________________________
Publish by. http://psikologi.uin-malang.ac.id
UNIVERSITAS ISLAM NEGERI MAULANA MALIK IBRAHIM MALANG
LSO PEER COUNSELING OASIS
DEWAN MAHASISWA FAKULTAS PSIKOLOGI
PERIODE 2013
Sekretariat :Gedung Student Center Lt 1, Jl Gajayana No 50 Malang
Telp: 085736918029
FORM PENDAFTARAN
RELAWAN TeSA (Telepon Sahabat Anak)
Nama
: ............................................................................
NIM
: ............................................................................
Fak/Jurusan
: ............................................................................
Angkatan (Semester)
: ............................................................................
IPK
: ............................................................................
No HP
: ............................................................................
Alamat di Malang
: ............................................................................
............................................................................
Kegiatan sehari-hari
: a. ........................................................................
b. ........................................................................
c. ........................................................................
d. ........................................................................
e. ........................................................................
Alasan Mendaftar Sebagai Relawan TeSA?
...................................................................................................
...................................................................................................
...................................................................................................
...................................................................................................
........................................................................
Dengan ini saya yang beridentitas di atas menyatakan bahwa:
1. BERSEDIA mengikuti kegiatan yang telah diagendakan.
2. Menerima hasil keputusan penetapan peserta dari panitia.
Malang, …… Desember 2013
Nama:
_____________________________
Publish by. http://psikologi.uin-malang.ac.id
REPUBLIK MAHASISWA
UNIVERSITAS ISLAM NEGERI MAULANA MALIK IBRAHIM MALANG
LSO PEER COUNSELING OASIS
DEWAN MAHASISWA FAKULTAS PSIKOLOGI
PERIODE 2013
Sekretariat :Gedung Student Center Lt 1, Jl Gajayana No 50 Malang
Telp: 085736918029
NIM:
_______________________________
Publish by. http://psikologi.uin-malang.ac.id