form biodata peserta un smp-sma

SMP/MTs/SMA/MA/SMK

BIODATA PESERTAPENDATAAN UJIAN NASIONAL SMP/MTs, SMA/MA dan SMK DINAS PENDIDIKAN KUTAI BARAT TAHUN 2011/2012

Nama NIP Jabatan Pangkat/Gol. Unit Kerja Alamat Sekolah Kode Pos Telp. Sekolah Alamat Rumah Kode Pos Telp. Rumah No. HP(harus diisi)

: ................................................................................................................................ : ................................................................................................................................ : ................................................................................................................................ : ................................................................................................................................ : ................................................................................................................................ : ............................................................................................................................... ............................................................................................................................... : ................................. : ..................................................................... Fax : ................................................. : ................................................................................................................................ ................................................................................................................................ : ................................. : ............................................................................................................................... : ................................................................................................................................ : ............................................................................................................................... : ................................................................................................................................

Alamat email(harus memiliki)

Website

Nama Sekolah NIP No. HP (Kepsek)(harus diisi)

: ................................................................................................................................ : ................................................................................. .............................................. : ................................................................................. ..............................................

Nama Kepala Sekolah : ...............................................................................................................................

........................, ...................................... 2010 Mengetahui, Kepala Sekolah Peserta,

. NIP. ..

. NIP. ..

Bidang Peningkatan Mutu Pendidikan Dinas Pendidikan Kutai Barat email: disdik_kubar_pmp@yahoo.com