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BIODATA PESERTA PERINGKAT 2 PROVINSI

FESTIVAL DAN LOMBA SENI SISWA NASIONAL (FLS2N) SMP TAHUN 2018
DIREKTORAT PEMBINAAN SEKOLAH MENENGAH PERTAMA

HARAP DIISI DENGAN HURUF KAPITAL

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

Tempat/Tanggal Lahir : ..................................................................................................................
NISN : ......................................................................................................................
Agama : ......................................................................................................................
Asal Sekolah : ........................................................................................... Negeri/Swasta
NPSN : ......................................................................................................................
Kelas : VII (tujuh) VIII (delapan) IX (sembilan)
Cabang Lomba :
Musik Tradisional

Tari Tradisional

Menyanyi Solo

Gitar Solo

Desain Poster

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

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Kab./Kota : ......................................................................................................................
Provinsi : ......................................................................................................................
Telepon Sekolah :( ) ................................................
Email Sekolah : ......................................................................................................................
Alamat Rumah : ......................................................................................................................
..........................................................................................................................
Telepon Rumah :( ) ................................................ hp: ................................................
Email Pribadi* : ......................................................................................................................
Nama Orang Tua : Ayah ……......……….....…..... Ibu ..............……………….......…...............
Pekerjaan Orang Tua : Ayah ......…………….....…..... Ibu…….......…………………......….................
Prestasi : ......................................................................................................................
……………………………………………… 2018
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(*) Nomor HP & Email wajib diisi agar dapat dihubungi sekretariat lomba-lomba untuk pencairan Dana
Beasiswa Bakat & Prestasi