FORMULIR PEMINATAN

EKSTRAKURIKULER
SMK SAINS MEDIKA

Nama : _______________________________________
Kelas : _______________________________________
Cita-Cita : _______________________________________
Hobby : _______________________________________

DAFTAR PROGRAM EKTRAKURIKULER

1. Ektrakurikuler Wajib
a. Pramuka ( X dan XI )

2. Ektrakurikuler Wajib Pilihan

a. Basket Ball
b. Volly Ball

PILIHAN I : ________________________________________

PILIHAN II : ________________________________________

Alasan memilih Program Ekstrakurikuler :

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Serang, ..........................................
Siswa

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