BIODATA PESERTA

FESTIVAL LOMBA SENI SISWA NASIONAL (FLS2N)

TINGKAT KECAMATAN SE-KABUPATEN PRINGSEWU TAHUN 2019
( ................................................................................... )

ASAL SEKOLAH : .................................................................................

ASAL KECAMATAN : .................................................................................

A. IDENTITAS PRIBADI
Nama Lengkap : .......................................................................................................................
Tempat Tanggal lahir : .......................................................................................................................
NISN : .......................................................................................................................
Agama : .......................................................................................................................
Kelas : .......................................................................................................................
Alamat Rumah : Jalan .........................................................................................
Kel/Pekon .........................................................................................
Kecamatan .........................................................................................
Kabupaten .........................................................................................
Telp./HP .........................................................................................

B. IDENTITAS SEKOLAH
Nama Sekolah : .......................................................................................................................

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

Kel/Pekon .........................................................................................
Kecamatan .........................................................................................
Kabupaten .........................................................................................
Telp./HP .........................................................................................

Pringsewu, Februari 2019

(............................................................)
NISN.