DINAS PENDIDIKAN
CABANG DINAS PENDIDIKAN WILAYAH XIII
SAKOLAH MENENGAH KEJURUAN NEGERI 2
CIAMIS
Jalan Sadananya No. 21Tlp. (0265) 773510
Faximili: (0265) 775407 Ciamis website: http:www.smkn2-cms.sch.id E-mail:
smkn2cms@gmail.com
CIAMIS - 46214
Nama : ..............................................................................
NIS : ..............................................................................
Kelas : ..............................................................................
Alamat : ..............................................................................
..............................................................................
Ciamis, ............................
Mengetahui, Siswa,
Orang Tua/Wali *)
......................................... .......................................
..
Disetujui,
Ketua Program Keahlian
..................................................................
..................................................................
NIP. ...........................................................
PEMERINTAH DAERAH PROVINSI JAWA BARAT
DINAS PENDIDIKAN
CABANG DINAS PENDIDIKAN WILAYAH XIII
SAKOLAH MENENGAH KEJURUAN NEGERI 2
CIAMIS
Jalan Sadananya No. 21Tlp. (0265) 773510
Faximili: (0265) 775407 Ciamis website: http:www.smkn2-cms.sch.id E-mail:
smkn2cms@gmail.com
CIAMIS - 46214