Professional Documents
Culture Documents
BIDANG LOMBA
.....................................................
1. Nama Peserta
........................................................................
2. Jenis Kelamin
Laki-laki / Perempuan *)
3. NIS
........................................................................
4. Tempat/Tanggal Lahir
........................................................................
5. Agama
........................................................................
6. Program Keahlian
7. Asal Sekolah
SMK .................................................................
8. Alamat Sekolah
Jl. ....................................................................
........................................................................
......................................................................
..
(.......) ..................
9. Alamat Rumah
Jl. ....................................................................
........................................................................
Kab./Kota*) ......................................................
Provinsi ...........................................................
Pas
Photo
3X4
Mengetahui;
Kepala Sekolah
SMK ............................................
Peserta,
.......................................
...................................
NIP.
Catatan :
PANITIA
LOMBA KOMPETENSI SISWA (LKS) SMK XX
TINGKAT PROPINSI JAWA TIMUR TAHUN 2012
PANITIA
LOMBA KOMPETENSI SISWA (LKS) SMK XX
TINGKAT PROPINSI JAWA TIMUR TAHUN 2012
BIDANG LOMBA
.....................................................
........................................................................
2. Jenis Kelamin
Laki-laki / Perempuan *)
3. NIP
........................................................................
4. Tempat/Tanggal Lahir
........................................................................
5. Agama
........................................................................
6. Jabatan Dinas
........................................................................
7. Unit Kerja
SMK .................................................................
Jl. ....................................................................
........................................................................
......................................................................
..
............................................................
............
(.......) ..................
Alamat Rumah
Jl. ....................................................................
........................................................................
Kab./Kota*) ......................................................
Provinsi ...........................................................
Pas
Photo
3X4
Mengetahui;
Kepala Sekolah
SMK ............................................
Pembimbing,
.......................................
...................................
NIP.
Catatan :
PANITIA
LOMBA KOMPETENSI SISWA (LKS) SMK XX
TINGKAT PROPINSI JAWA TIMUR TAHUN 2012
KABUPATEN/KOTA
.....................................................
........................................................................
2. Jenis Kelamin
Laki-laki / Perempuan *)
3. NIP
........................................................................
4. Tempat/Tanggal Lahir
........................................................................
5. Agama
........................................................................
6. Jabatan Dinas
........................................................................
7. Unit Kerja
................................................................
Jl. ....................................................................
........................................................................
......................................................................
..
............................................................
............
(.......) ..................
Alamat Rumah
Jl. ....................................................................
........................................................................
Kab./Kota*) ......................................................
Provinsi ...........................................................
Pas
Photo
3X4
...................................
NIP.
PANITIA
LOMBA KOMPETENSI SISWA (LKS) SMK XX
TINGKAT PROPINSI JAWA TIMUR TAHUN 2012
Catatan :