FORMULIR

PENDIDIKAN DAN PELATIHAN SASTRA DAN TEATER (DIKLAT STATER)

PONDOK TEATER DAN SENI (POTES)
SMA NEGERI 2 KENDARI
KEPENGURUSAN 2016/2017

FOTO GAYA BEBAS

UKURAN 4 X 6
(UKURAN DOMPET)

Nama

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

Kelas

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

No Hp

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

Tempat Tanggal Lahir

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

Jenis Kelamin

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

Agama

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

Alamat

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

Nama Orang Tua

: Ayah :................................

Ibu :................................ ......

No Hp

: Ayah :................................

Ibu : .....................................

Pekerjaan

: Ayah : ...............................

Ibu : ....................................

Hobbi

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

Alat Musik Yang Bisa Dimainkan :....................................................................... .......... ......

..................................................................................................................................................
Seni Yang Di Minati :...............................................................................................................
......................................................................................................................................................
Pentas Seni Yang Sudah Dimainkan:......................................................................................
.....................................................................................................................................................
Sanggar Seni Yang Pernah Di ikuti:.......................................................................................
....................................................................................................................................................
Alasan Masuk Ke Sanggar Seni Potes:..................................................................................
.....................................................................................................................................................

Kendari,....................................2016
Peserta,

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

NAMA-NAMA PESERTA
DIKLAT STATER POTES
SMA NEGERI 2 KENDARI
NOMO
R
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
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39
40

NAMA

KELAS