BIODATA PESERTA

1. NAMA : ...........................................................................

2. NIP. : ................................................................................................

3. PANGKAT / GOL. : ................................................................................................

4. TEMPAT, TANGGAL LAHIR : ................................................................................................

5. NIK. / NO. KTP. : ................................................................................................

6. NUPTK. : ................................................................................................

7. JABATAN : ................................................................................................

8. MAPEL : ................................................................................................

9. UNIT KERJA : SMK Negeri 1 Sukadana

10. ALAMAT UNIT KERJA : Jl. Bhayangkara, RT/RW 19/04, Ds. Sutera, Kec.

Sukadana, Kab. Kayong Utara, Kalimantan Barat

11.NPWP : ................................................................................................

12.ATAS NAMA (NPWP) : ................................................................................................

13.ALAMAT (NPWP) : ................................................................................................

....................................................................................

14.NO. TELP. / HP. / WA. AKTIF : ................................................................................................

15.ALAMAT E-MAIL : ................................................................................................

16. KEGIATAN : In House Training (IHT) Sekolah Pusat Keunggulan

Skema Reguler Baru Tahun 2023

Kayong Utara, Oktober 2023

( )

NIP.
 BIODATA NARASUMBER

1. NAMA : ................................................................................................

2. NIP. : ................................................................................................

3. PANGKAT / GOL. : ................................................................................................

4. TEMPAT, TANGGAL LAHIR : ................................................................................................

5. NIK. / NO. KTP. : ................................................................................................

6. NUPTK. : ................................................................................................

7. JABATAN : ................................................................................................

8. MAPEL : ................................................................................................

9. UNIT KERJA : ....................................................................................

10. ALAMAT UNIT KERJA : ....................................................................................

....................................................................................

11.NPWP : ................................................................................................

12.ATAS NAMA (NPWP) : ................................................................................................

13.ALAMAT (NPWP) : ................................................................................................

....................................................................................

14.NO. TELP. / HP. / WA. AKTIF : ................................................................................................

15.ALAMAT E-MAIL : ................................................................................................

16. KEGIATAN : In House Training (IHT) Sekolah Pusat Keunggulan

Skema Reguler Baru Tahun 2023

Kayong Utara, Oktober 2023

( )

NIP.
 BIODATA PANITIA

1. NAMA : ................................................................................................

2. NIP. : ................................................................................................

3. PANGKAT / GOL. : ................................................................................................

4. TEMPAT, TANGGAL LAHIR : ................................................................................................

5. NIK. / NO. KTP. : ................................................................................................

6. NUPTK. : ................................................................................................

7. JABATAN : ................................................................................................

8. MAPEL : ................................................................................................

9. UNIT KERJA : ....................................................................................

10. ALAMAT UNIT KERJA : ....................................................................................

....................................................................................

11.NPWP : ................................................................................................

12.ATAS NAMA (NPWP) : ................................................................................................

13.ALAMAT (NPWP) : ................................................................................................

....................................................................................

14.NO. TELP. / HP. / WA. AKTIF : ................................................................................................

15.ALAMAT E-MAIL : ................................................................................................

16. KEGIATAN : In House Training (IHT) Sekolah Pusat Keunggulan

Skema Reguler Baru Tahun 2023

Kayong Utara, Oktober 2023

( )

NIP.