Formulir Pendaftaran STT SANGKAKALA

SEKOLAH TINGGI TEOLOGI SANGKAKALA

FORMULIR PENDAFTARAN PENDAFTARAN

1. a$a /eng'ap /eng'ap % %        2. Jeni& Jeni& Kela$in Kela$in % /ela'i  Pee$p3an Pee$p3an 4 . Te$pat Te$pattangga tanggall la)i %        ". la$at la$at /eng'ap %           

 

 

  Telp. Telp.    ax.  

5. Ke6aganega Ke6aganegaaan aan % -  - Ket33nan Ket33nan   4 !. Penii'a Penii'an n o$al Tea')i Tea')i %       7. a$a Se'ola) Se'ola) Tea')i Tea')i %             /3l3& Ta)3n %   8. Pe'eaan Pe'eaan ana tea')i tea')i ini %                9. a$a Pe3&a) Pe3&a)aan aan te$pat te$pat ana :ee'a :ee'a %              10. 10.

la$ la$at at Pe Pe3&a 3&a) )aan aan %                            

1

Telp.  ax.   11.

Stat3& na % Single  Meni'a)  +3a  Jana 4

12.

na $enai anggota i geea %  

1.

la$at ;eea ana %    

1".

Telp. ax.   pa'a) ana &3a) i:apti& < S3a):el3$ 4

15.

Ta)3n %   pa'a) ana &3a) $elayani <

=a  Tia' 4

1!.

Jeni& pelayanan ana %     

17.

Talenta > Ba'at ana %     

18.

?a$:atan 3ta$a ala$ pet3$:3)an 'eo)anian ana %  

19.

?a$:atan 3ta$a ala$ pelayanan ana %     

20.

Beapa 'ali ana tela) $enyele&ai'an &el33) pe$:a*aan l'ita: <  

21.

?a$:a T3)an yang paling $e$penga3)i pet3$:3)an o)ani ana %  

22.

pa'a) ana &aat ini :e)3tang < =a, &e:e&a Rp. 

2.

Tia' 4

+ai $ana ana $enapat'an in@o$a&i tentang STT Sang'a'ala <  

2".

pa'a) ana i3t3& ole) geea <

=a  Tia' 4

25.

a$a ;eea Peng3t3& %  

2!.

   la$at ;eea Peng3t3& %      Telp.  ax.  

27.

pa'a) ana tei'at ani engan ;eea Peng3t3& < =a  Tia' 4

28.

Siapa'a) yang $enangg3ng :iaya '3lia) ana i STT Sang'a'ala <  

2

29.

la$at Penangg3ng Biaya St3i na %         Telp.  ax.  

+T KA/R; % 0.

a$a ya) %  

1.

a$a -:3 %   la$at Oangt3a %      Telp.  ax.  

2.

Penii'an Tea')i ya) %   Penii'an Tea')i -:3

%  

.

ga$a ya) %  

".

ga$a -:3 %   Pe'eaan ya) %  

5.

Pe'eaan -:3 %   a$a Sa3aa Kan3ng Be&a$a na %

o

a$a

Jeni&

$3 

Kela$in

Penii'an

ga$a

Tea')i 

1 2  " 5 ! 7 8 !.

pa'a) ana &e'aang ini &eang :epa*aan  :et3nangan < =a  Tia' 4

7.

Be&eia'a) ana $ena)an ii 3nt3' tia' :epa*aan &ela$a 5 &e$e&te peta$a ana '3lia) i



STT Sang'a'ala <

Be&eia  Tia' Be&eia

8.

a$a Pa*a  T3nangan 4 ana %  

9.

ga$a Pa*a  T3nangan 4 ana %  

"0.

Tanggapan Pa*a  T3nangan 4 ata& 'ep3t3&an ana $a&3' STT Sang'a'ala <

"1.

Be&eia'a) ana tia' $eni'a) &ela$a penii'an i STT Sang'a'ala <

"2.

pa'a) ana pena) :e*eai < =a  Tia' 4 pa ala&an pe*eaian ana <        

".

Bila ana $a&3' STT Sang'a'ala, &iapa'a) yang a'an $enai penangg3ng e'ono$i 'el3aga ana <

+T PA+-+-K > PAKARJ % "".

+ata Penii'an na %

o

Penii'an o$al

1

S+

2

S/TP



SM

a$a Se'ola)

Ta)3n /3l3&

a$a Se'ola)

Ta)3n /3l3&

" o

Penii'an on#o$al

1 2  " 5 "5. o

+ata Pe'eaan na % Ja:atan

a$a Pe3&a)aan

1 2 

"

Ta)3n

" +engan ini &aya $enyata'an :a)6a &aya tela) $engi&i @o$3li ini &e&3ai engan 'eaaan yang &e:enanya. +an :ila &aya itei$a, &aya :eani engan &3ngg3)#&3ngg3) 3nt3' :elaa an iii' i STT Sang'a'ala &e:agai pe&iapan &aya 3nt3' $enai )a$:a T3)an, an &aya $enyata'an :e&eia 3nt3' $entaati engan t3l3& an tanpa pa'&aan &e$3a 'etent3an yang :ela'3 i STT Sang'a'ala.

  ........................., .....................................

C  D a$a Teang Ealon Ma)a&i&6a

Eatatan % 4 F Eoet yang tia' ipel3'an. /a$pi'an Be&a$a o$3li Pena@taan ini engan % 1. oto*opy -aGa) tea')i yang tela) ilegali&i. 2. oto*opy a@ta nilai tea')i yang tela) ilegali&i. . oto*opy S3at Bapti&  Sii. ". S3at Re'o$ena&i ai ;eea 5. S3at Keteangan Stat3& Ke&e)atan ai +o'te. !. S3at Keteangan Kela'3an Bai' C SKKB D ai Kepoli&ian. 7. Ke&a'&ian Peto:atan C it3li& tangan  tia' i'eti' D. 8. Ke&a'&ian Panggilan C it3li& tangan  tia' i'eti' D. 9. Pa&@oto 3'3an % 2x , x" , "x! $a&ing#$a&ing 2 le$:a.

5