01. questioner pplp
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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.
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.
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.
.................................................................................................................................................................................................................................................................................
.................................................................................................................................................................................................................................................................................
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.
2. Event Nasional
Cabang Olahraga :......................................................................................................
Kejuaraan : .....................................................................................................
NAMA ATLETJML MEDALI
TEMPAT TAHUNPERUNGGU PERAK EMAS
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
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.
Cabang Olahraga :......................................................................................................
Kejuaraan : ASIAN GAMES
NAMA ATLETJML MEDALI
TEMPAT TAHUNPERUNGGU PERAK EMAS
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Cabang Olahraga :......................................................................................................
Kejuaraan : OLYMPIADE
NAMA ATLETJML MEDALI
TEMPAT TAHUNPERUNGGU PERAK EMAS
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Cabang Olahraga :......................................................................................................
Kejuaraan : (lainnya)......................................................................................
NAMA ATLETJML MEDALI
TEMPAT TAHUNPERUNGGU PERAK EMAS
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
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)
..............................................................................................................................................................................................................................................................................
..............................................................................................................................................................................................................................................................................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.
2. Event Nasional
Cabang Olahraga :......................................................................................................
Kejuaraan : .....................................................................................................
NAMA PELATIHJML MEDALI
TEMPAT TAHUNPERUNGGU PERAK EMAS
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
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.
Cabang Olahraga :......................................................................................................
Kejuaraan : ASIAN GAMES
NAMA PELATIHJML MEDALI
TEMPAT TAHUNPERUNGGU PERAK EMAS
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Cabang Olahraga :......................................................................................................
Kejuaraan : OLYMPIADE
NAMA PELATIHJML MEDALI
TEMPAT TAHUNPERUNGGU PERAK EMAS
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
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.
G. Kejuaraan Antar PPLP
NAMA ATLET ALAMAT CABORJLH MEDALI TEMPAT,
TAHUN KETERANGANPerunggu Perak Emas
1.
2.
3.
4.
5.
6.
7.
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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