FORM PENDAFTARAN TC 2017

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Email : [email protected] Website : www.globalenglishpare.com

FORMULIR PENDAFTARAN PROGRAM TEACHING CLINIC A. KETERANGAN PRIBADI

Nama Lengkap : ________________________________________________________________ Tempat dan tanggal lahir : ________________________________________________________________ Agama : ________________________________________________________________ Jenis kelamin : (Laki-laki/Perempuan)

Status : (Belum nikah/Nikah)

Nama Orangtua : ________________________________________________________________ Alamat asal : ________________________________________________________________ Kota/Kab/Propinsi : _______________________________(Kode Pos)________________________ Telepon : ________________________________________________________________ E-mail / FB/Twitter : ________________________________________________________________ Pendidikan Terakir : ________________________________(SMA/D3/D4/S1)

Skill ( Sebutkan ) : __________________________________________________________

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Pengalaman Belajar Bahasa Inggris ( Sebutkan )

N

o Nama Lembaga Program

Lama Belajar Nilai 1 2 3 4 5 6 7 8

Form Pengalaman Organisasi

NAMA

ORGANISASI JABATAN TINGKAT

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Nama Kegiatan Peringkat Tingkat Tempat Tahun

ALASAN MENGIKUTI PROGRAM TEACHING CLINIC

Mengapa saudara berkeinginan mengikuti program Teaching Clinic, beri alasan-alasan yang kuat :

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APA PENDAPAT ANDA TENTANG GLOBAL ENGLISH?

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Ceritakan Mengapa anda layak diterima dalam program Teaching Clinik dalam paragraf pendek pada kolom di bawah ini ;