PANGKALAN SMA LAB. SCHOOL UPI Jl. Senjayaguru Kampus UPI Tlp. (022)2004404 Bandung (40154) Website: sma.labschool.upi.edu E-mail: Sma_labschool@upi.edu
FORMULIR PENDAFTARAN A. Identitas Diri Nama Lengkap Nama Panggilan NIS TTL Agama Alamat Asal Alamat Sekarang Alamat Email No. Kontak B. Identitas Keluarga Orang Tua/Wali 1. Nama ayah Pekerjaan Alamat 2. Nama Ibu Pekerjaan Alamat Saudara Kandung C. Riwayat Pendidikan SD/MI SMP/MTS SMA D. Riwayat Kepramukaan SIAGA PENGGALANG
: .............................................................................. : .............................................................................. : .............................................................................. : .............................................................................. : .............................................................................. : .............................................................................. : Jumlah Kakak : ................... Jumlah Adik : ..................... : .................................................................................... Lulus Tahun : .............. : .................................................................................... Lulus Tahun : .............. : .................................................................................... KELAS X : .............. : ................................................Tahun : ...................... Jabatan : ........................... : ................................................Tahun : ...................... Jabatan : ...........................
E. Prestasi yang pernah diraih
1. .................................................................................................... 4............................................................................... 2. .................................................................................................... 5.............................................................................. 3. .................................................................................................... 6.............................................................................. F. Organisasi yang pernah diikuti 1. .................................................................................................... 4.............................................................................. 2. .................................................................................................... 5.............................................................................. 3. .................................................................................................... 6.............................................................................. G. Motivasi Masuk Pramuka ............................................................................................................................................................................................. ............................................................................................................................................................................................. ............................................................................................................................................................................................. ...........................................................................................................................................................................................
Bandung, Agustus 201 Pendaftar,
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GERAKAN PRAMUKA GUDEP 01005 01006 KOTA BANDUNG PANGKALAN SMA LAB. SCHOOL UPI Jl. Senjayaguru Kampus UPI Tlp. (022)2004404 Bandung (40154) Website: sma.labschool.upi.edu E-mail: Sma_labschool@upi.edu
