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BIODATA PESERTA
Kegiatan Seleksi Paskibraka
Tingkat Kabupaten Lampung Tengah
Tahun 2023

1. Nama Lengkap :.............................................................................................


2. Tempat / Tanggal Lahi : ............................................................................................
3. Jenis Kelamin : ............................................................................................
4. Kelas : ...........................................................................................
5. Nama Sekolah : ............................................................................................
6. Alamat Sekolah Jalan : ............................................................................................
Kampung / Desa : ............................................................................................
Kecamatan : ...........................................................................................
7. Alamat Rumah Jalan : ............................................................................................
Kampung / Desa : ............................................................................................
Kecamatan : ............................................................................................
8. Nama Orangtua / Wali : ............................................................................................
9. No. Telp Rumah / Hp : .............................................................................................
10. Email : .............................................................................................
11. Tinggi Badan : .............................................................................................
12. Berat Badan : ..............................................................................................

……………………, ……. ……………….. 2023

………………………………………………
NISN

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