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MUSYAWARAH KERJA KEPALA SEKOLAH

(MKKS) SMK WILKER IV


PANITIA LKS TAHUN 2018
Sekretariat: SMKN 3 Madiun , Jln. Mayjend Panjaitan No. 20 A MADIUN

BIODATA PESERTA LKS SMK

BIDANG LOMBA : ..........................................................................................................

A. IDENTITAS PESERTA

1. Nama Peserta : ....................................................................................................


2. Tempat tanggal lahir : ....................................................................................................
3. Jenis Kelamin : ....................................................................................................
4. NIS/NISN : ....................................................................................................
5. Kelas : ....................................................................................................
6. Kompetensi Keahlian : ....................................................................................................
7. Alamat Rumah : ....................................................................................................
...................................................................................................
8. No Telepon/HP : ..................................................................................................

B. IDENTITAS SEKOLAH

1. Asal Sekolah : ....................................................................................................


2. NSS/NPSP : ....................................................................................................
3. Alamat Sekolah : ....................................................................................................
No. Telepon Sekolah : ....................................................................................................
4, Nama Kepala Sekolah : ....................................................................................................
No Telepon/HP : ..................................................................................................

Mengetahui ..................................., ............................


Kepala SMK ............................................... Peserta,

....................................................................... ...............................................................
........................................................................ NIS

Mohon melampirkan:
1. FC Raport Smt 1 s.d. 5
2. Pasfoto 4 x 6 (2 lembar)

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