Formulir Pendaftaran LKS

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MUSYAWARAH GURU MATA PELAJARAN

TEKNIK KENDARAAN RINGAN


SMK KABUPATEN TEGAL

FORMULIR PENDAFTARAN LOMBA KOMPETENSI SISWA


MATA LOMBA AUTOMOBILE TECHNOLOGY
TINGKAT KABUPATEN TEGAL
TAHUN 2017

A. IDENTITAS PESERTA
1. Nama Peserta : ................................................................................
2. NISN : ................................................................................
3. Jenis Kelamin : ................................................................................
4. Tempat/Tanggal Lahir : ................................................................................
5. Agama : ................................................................................
6. Alamat Rumah : ................................................................................
7. Asal Sekolah : ................................................................................
8. No. Handphone : ................................................................................

B. IDENTITAS PEMBIMBING
1. Nama Pembimbing : ................................................................................
2. NIP/NIY : ................................................................................
3. Jenis Kelamin : ................................................................................
4. Tempat/Tanggal Lahir : ................................................................................
5. Asal Sekolah : ................................................................................
6. Alamat Sekolah : ................................................................................
7. No. Telp/Handphone : ................................................................................
8. No. Telp Sekolah : ................................................................................
9. Email : ................................................................................

Tegal, ...............................................
Mengetahui,
Kepala SMK .....................................

(........................................................)
NIP/NIY ............................................

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