FORMULIR PENDAFTARAN

KALBE JUNIOR SCIENTIST AWARD 2016

Informasi Sekolah/Club Sains
Nama sekolah/Club Sains

: .......................................................................................................

Alamat

: .......................................................................................................
: .......................................................................................................

Telepon

: ......................................................................................................

Fax

: ......................................................................................................

Nama Pendaftar

: ......................................................................................................

Jabatan

: ......................................................................................................

HP

: ......................................................................................................

Email
: .......................................................................................................
Informasi Peserta Siswa
Nama Peserta & Tim (Jika Ada):
Peserta Ketua : ........................................................ Kelas : ........................................
Peserta Anggota: .................................................... Kelas : ........................................
Nama Pembimbing: ....................................................................................................................
HP Pembimbing : .........................................................................................................................
Email Pembimbing : ...
Nama orang tua dari:
Peserta Ketua : ........................................................ Kelas : ........................................
Peserta Anggota: .................................................... Kelas : ........................................
Judul Karya : ..................................................................................................................................
.......................................................................................................................................................
....................., ..................................., 2016
Cap sekolah/lembaga dan Tanda Tangan

Nama Lengkap
Lampiran
1. Penjelasan/keterangan tertulis mengenai hasil percobaan
(format disediakan)
2. Materi tambahan : Foto/Gambar/Video (audio video) *
3. Foto siswa & Tim............................................................................................
4. Catatan guru/Pembimbing..............................................................................

FORMAT PENJELASAN TERTULIS

Dalam membuat penjelasan tertulis dari karya sains yang didaftarkan, ada tiga tahapan yang
harus tersedia:

I.

IDE

Pengamatan, perumusan masalah

...........................................................................................................................................
...........................................................................................................................................

Latar belakang munculnya ide/topik yang dipilih?

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...........................................................................................................................................

Siapa yang ikut membantu dalam penemuan masalah dan ide

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...........................................................................................................................................
II.

PROSES
Menerangkan proses dari:

Tahapan/metode melakukan percobaan karya sains

...........................................................................................................................................
...........................................................................................................................................

Bagaimana memperoleh bahan/informasi/data

...........................................................................................................................................
...........................................................................................................................................

Siapa saja yang membantu dalam proses melakukan percobaan

...........................................................................................................................................
...........................................................................................................................................

Kesulitan yang dialami

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...........................................................................................................................................

II.

HASIL/KEGUNAAN/SOLUSI

Bagaimana hasil percobaan dari karya sains ?

...........................................................................................................................................
...........................................................................................................................................

Apakah hasil percobaan memberikan solusi untuk menjawab permasalahan?

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...........................................................................................................................................

Apakah hasil percobaan memiliki manfaat?

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CATATAN GURU PEMBIMBING

(1) Apa keunikan/kelebihan dari karya sains yang didaftarkan anak bimbing?
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(2) Apa yang memotivasi/menginspirasi anak bimbing sehingga tertarik membuat karya sains
tersebut?
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(3) Bagaimana tingkat kesulitan anak bimbing dalam merealisasikan karya sains tersebut?
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(4) Apa yang dilakukan anak bimbing dalam mengatasi kesulitan-kesulitan tersebut?
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....................., ..................................., 2016

Pembimbing

Tanda Tangan

Nama Lengkap

* Semua kelengkapan pendaftaran silahkan email ke : kalbe.jsa@gmail.com atau

kjsa@tempo.co.id Informasi lengkap hubungi : (021) 536 0409 ext. 314 / 0853 1144 5561