BIODATA PESERTA

OLIMPIADE SAINS NASIONAL SMP TINGKAT KABUPATEN

TAHUN 2018

HARAF DIISI DENGAN HURUF KAPITAL

1 . Nama Lengkap : ..................................................................................................

2 . Tempat / Tanggal Lahir : ..................................................................................................

3 . NISN : ..................................................................................................

4 . Agama : ..................................................................................................

5 . Asal Sekolah : ...................................................................................................

6 . NPSN : ...................................................................................................

7 . Kelas : VII (Tujuh) VIII (Delapan)

8 . Mata Pelajaran : 1. IPA 2.IPS 3. MATEMATIKA 4. PPKn

9 . Alamat Sekolah : ...................................................................................................

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10 . Telepon Sekolah : Telp............................................Hp..........................................

11 . Email Sekolah : ..................................................................................................

12 . Alamat Rumah : ..................................................................................................

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13 . Telepon Rumah : Telp............................................Hp..........................................

14 . Email Pribadi : ....................................................................................................

15 . Kab./Kota : ....................................................................................................

16 . Provinsi : ....................................................................................................

17 . Nama Orang Tua : Ayah ........................................... Ibu .........................................

18 . Pekerjaan Orang Tua : Ayah ........................................... Ibu .........................................
19 . Prestasi : .....................................................................................................

Sukabumi, Maret 2018

3x4
4 Lembar

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