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FORMULIR PENDAFTARAN

JUNIOR SCIENTIST AWARD


Informasi Sekolah
Nama sekolah

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

Alamat

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

Telepon

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

Fax

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

Nama Pendaftar: ...........................................................................................................................


Jabatan

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

HP

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

Email

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

Informasi Peserta Siswa


Nama Peserta & Tim (Jika Ada):
Ketua : ...........................................................................................................................
Tim
Kelas

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

Nama Pembimbing: ..................................................................................................


Bidang science yang diajukan:

Judul Percobaan/Project : .............................................................................................................


.......................................................................................................................................................
......................................................................................................................................................
Lampiran
1. Penjelasan tertulis mengenai percobaan/project
2. Foto hasil percobaan/peraga .
3. Foto siswa & Tim............................................................................................
....................., ..................................., 2011

Cap sekolah dan Tanda Tangan


Nama Lengkap

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