OLIMPIADE SAINS NASIONAL (OSN) 2023

DATA SISWA
Nama Lengkap* :....................................................................................................
NISN* :....................................................................................................
Tempat Tanggal Lahir* :....................................................................................................
Berat Badan* :....................................................................................................
Tinggi Badan* :....................................................................................................
Foto Formal* : (ukuran maksimal 500 kb) JPG, JPEG
NIK* :....................................................................................................
Email Aktif* :....................................................................................................
Nomor Telepon* :....................................................................................................
WA* :....................................................................................................
Alamat Korespondensi* :....................................................................................................
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RT/RW* :....................................................................................................
Kelurahan* :....................................................................................................
Kecamatan*: :....................................................................................................
Kode Pos* :....................................................................................................

DATA ORANG TUA/WALI

Nama Ibu* :....................................................................................................
Pekerjaan Ibu :....................................................................................................
Pendidikan Terakhir Ibu* :....................................................................................................
Nama Ayah* :....................................................................................................
Pekerjaan Ayah* :....................................................................................................
Pendidikan Terakhir Ayah*:..................................................................................................
Nomor orang tua/ wali* :....................................................................................................
Alamat Jalan* :....................................................................................................
.....................................................................................................
Nomor Rumah* :....................................................................................................
RT/RW* :....................................................................................................
Kelurahan* :....................................................................................................
Kecamatan* :....................................................................................................
Kabupaten* :....................................................................................................
Kode Pos* :....................................................................................................
DATA PEMBIMBING
Nama* :....................................................................................................
Email* :....................................................................................................
NIK* :....................................................................................................
NIP :....................................................................................................
NUPTK :....................................................................................................
NIDN :....................................................................................................
Jenis Kelamin* :....................................................................................................
Tempat Tanggal Lahir* :....................................................................................................
No. Telp/HP/ Whatsap* :....................................................................................................
Alamat Jalan* :....................................................................................................
Nomor Rumah* :....................................................................................................
.....................................................................................................
RT/RW* :....................................................................................................
Kelurahan* :....................................................................................................
Kabupaten Kota* :....................................................................................................
Provinsi* :....................................................................................................
Kode Pos* :....................................................................................................
Nama Satuan Pendidikan*:....................................................................................................
Informasi Tambahan :....................................................................................................
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