Lampiran :2

Nomor : 03/POMT-MTsN2/I/2019

KOMPETISI MIPA DAN TAHFIDZUL QUR’AN

MTs NEGERI 2 KOTA SEMARANG
TINGKAT SD/MI SE KOTA SEMARANG

FORMULIR PENDAFTARAN

Nama Sekolah/Madrasah : …………………………………….

Alamat Sekolah/Madrasah : …………………………………….

Contact Person : …………………………………….

1. Jenis Lomba Kompetisi Matematika

Nama lengkap : .................................................................................................
Pas Photo

Kelas : ................................................................................................. 3x4

Tempat lahir : .................................................................................................

Tanggal lahir : .................................................................................................

2. Lomba Kompetisi IPA

Nama lengkap : .................................................................................................
Pas Photo

Kelas : ................................................................................................. 3x4

Tempat lahir : .................................................................................................

Tanggal lahir : .................................................................................................

3. Lomba Kompetisi Tahfidzul Qur’an

Nama lengkap : .................................................................................................Pas Photo
Kelas : .................................................................................................
3x4
Tempat lahir : .................................................................................................
Tanggal lahir : .................................................................................................
Juz yang dihafal : .................................................................................................

Semarang, .....................................2019
Kepala SD/MI....................................

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NIP