01. questioner pplp
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pulpTRANSCRIPT
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FORM ISIANPUSAT PENDIDIKAN DAN LATIHAN OLAHRAGA PELAJAR (PPLP)
TAHUN 2012
PROVINSI: ………………………………………
A. Data Lembaga PPLP
NAMA LEMBAGA CABOR THN BERDIRI
ALAMAT TELP, FAX, EMAIL
1.
2.
3.
4.
5.
6.
7.
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B. Kepengurusan PPLP Tahun 2012
NAMA LEMBAGA CABORPENGELOLA
JML ATLET JML PELATIHNAMA
KETUA ALAMAT/ TELP NAMA WAKIL ALAMAT/ TELP
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
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C. Data Atlet PPLP tahun 2012
NAMA L/P GOL. DARAH
TGG BADAN
BRT BADAN
TEMPAT, TANGGAL LAHIR CABOR PENDIDIKAN ALAMAT/ TELP,
FAX, EMAIL MASUK
PPLP1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
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D. Data Prestasi Atlet PPLP Tahun 2012
1. Event Daerah
Cabang Olahraga : .....................................................................................................
Kejuaraan : .....................................................................................................
NAMA ATLETJML MEDALI
TEMPAT TAHUNPERUNGGU PERAK EMAS
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
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2. Event Nasional
Cabang Olahraga :......................................................................................................
Kejuaraan : .....................................................................................................
NAMA ATLETJML MEDALI
TEMPAT TAHUNPERUNGGU PERAK EMAS
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
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3. Event Internasional
Cabang Olahraga :......................................................................................................
Kejuaraan : SEA GAMES
NAMA ATLETJML MEDALI
TEMPAT TAHUNPERUNGGU PERAK EMAS
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
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Cabang Olahraga :......................................................................................................
Kejuaraan : ASIAN GAMES
NAMA ATLETJML MEDALI
TEMPAT TAHUNPERUNGGU PERAK EMAS
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
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Cabang Olahraga :......................................................................................................
Kejuaraan : OLYMPIADE
NAMA ATLETJML MEDALI
TEMPAT TAHUNPERUNGGU PERAK EMAS
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
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Cabang Olahraga :......................................................................................................
Kejuaraan : (lainnya)......................................................................................
NAMA ATLETJML MEDALI
TEMPAT TAHUNPERUNGGU PERAK EMAS
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
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Petunjuk Pengisian Kuesioner :Form Data Prestasi Atlet bisa diperbanyak sesuai dengan kejuaraan yang diikuti masing – masing cabang olahraga.
E. Data Pelatih PPLP Tahun 2012
NAMA L/P TEMPAT, TANGGAL LAHIR CABOR PENDIDIKAN ALAMAT/ TELP,
FAX, EMAIL PEKERJAAN
KARIR KEPELATIHAN
(tanggal mulai melatih)
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..............................................................................................................................................................................................................................................................................F. Data Prestasi Peatih PPLP Tahun 2012
1. Event Daerah
Cabang Olahraga :......................................................................................................
Kejuaraan : .....................................................................................................
NAMA PELATIHJML MEDALI
TEMPAT TAHUNPERUNGGU PERAK EMAS
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
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2. Event Nasional
Cabang Olahraga :......................................................................................................
Kejuaraan : .....................................................................................................
NAMA PELATIHJML MEDALI
TEMPAT TAHUNPERUNGGU PERAK EMAS
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
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3. Event Internasional
Cabang Olahraga :......................................................................................................
Kejuaraan : SEA GAMES
NAMA PELATIHJML MEDALI
TEMPAT TAHUNPERUNGGU PERAK EMAS
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
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Cabang Olahraga :......................................................................................................
Kejuaraan : ASIAN GAMES
NAMA PELATIHJML MEDALI
TEMPAT TAHUNPERUNGGU PERAK EMAS
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
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Cabang Olahraga :......................................................................................................
Kejuaraan : OLYMPIADE
NAMA PELATIHJML MEDALI
TEMPAT TAHUNPERUNGGU PERAK EMAS
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
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Cabang Olahraga :......................................................................................................
Kejuaraan : (lainnya)......................................................................................
NAMA PELATIHJML MEDALI
TEMPAT TAHUNPERUNGGU PERAK EMAS
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Petunjuk Pengisian Kuesioner :Form Data Prestasi Pelatih bisa diperbanyak sesuai dengan kejuaraan yang diikuti masing – masing cabang olahraga.
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G. Kejuaraan Antar PPLP
NAMA ATLET ALAMAT CABORJLH MEDALI TEMPAT,
TAHUN KETERANGANPerunggu Perak Emas
1.
2.
3.
4.
5.
6.
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8.
9.
10.
H. Peluang dan Tantangan
1. Peluang Yang dihadapi PPLP
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2. Tantangan yang dihadapi PPLP
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Catatan
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