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BIODATA PESERTA
O2SN SMP TAHUN 2018
DIREKTORAT PEMBINAAN SMP
_______________________________________________________________________________________________

HARAP DIISI DENGAN HURUF KAPITAL

Nama Lengkap : ..............................................................L/P


Tempat/TanggalLahir : ......................................................................
NISN : .......................................................................
Agama : .......................................................................
Asal Sekolah : ........................................... Negeri/Swasta
NPSN : .......................................................................
Kelas : VII (tujuh) VIII (delapan)
Cabang Lomba : .....................................................................
Kategori Lomba : .....................................................................
Asal Klub : .....................................................................
Berat Badan : ............Kg
Tinggi Badan : ............Cm
Alamat Sekolah :......................................................................
......................................................................
Kab./Kota : .....................................................................
Provinsi : .....................................................................
Telepon Sekolah :( ) ......................................
Email Sekolah : ....................................................................
Alamat Rumah : .....................................................................
Alamat Sekolah : .....................................................................
Telepon Rumah :( ) .................. hp: .............................
Email Pribadi : .....................................................................
Nama Orang Tua : Ayah …………....... Ibu ..........................
Pekerjaan Orang Tua : Ayah .............…..... Ibu……...........…....
Prestasi : .....................................................................
………………… 2018

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