Formulir Pendaftaran LKS
Formulir Pendaftaran LKS
Formulir Pendaftaran LKS
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 ............................................