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BIODATA PESERTA

LOMBA APRESIASI DAN KREASI SENI ISLAMI SMP


TINGKAT KABUPATEN BEKASI
TAHUN 2018

HARAP DIISI DENGAN HURUF KAPITAL

Nama lengkap : ...............................................................................................


Tempat/ tanggal lahir : ...............................................................................................
Agama : ...............................................................................................
Asal Sekolah : ........................................................................Negeri / Swasta
NISN : ...............................................................................................
NPSN : ...............................................................................................
Kelas : VII (Tujuh) VIII (Delapan) IX (Sembilan)

Jenis Lomba : MTQ Pa/Pi MHQ Pa/Pi Cerdas Cermat

Ceramah Pa/Pi Kaligrafi Olimpiade PAI

Prestasi : ...............................................................................................
Alamat Sekolah : ...............................................................................................
...............................................................................................
Kab. / Kota : ...............................................................................................
Provinsi : ...............................................................................................
Email Sekolah : ...............................................................................................
Email Pribadi : ...............................................................................................
Alamat Rumah : ...............................................................................................
...............................................................................................
Telepon Rumah : (.......).....................................................................................
Nama Orang Tua : Ayah ......................................... Ibu .....................................
Pekerjaan Orang Tua : Ayah ......................................... Ibu .....................................
No HP Orang Tua : Ayah ......................................... Ibu .....................................
Email Orang Tua : Ayah ......................................... Ibu .....................................

Bekasi, Februari 2018

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