formulir

1. FORMULIR
PENDIDIKAN DAN PELATIHAN SASTRA DAN TEATER (DIKLAT STATER)
PONDOK TEATER DAN SENI (POTES)
SMA NEGERI 2 KENDARI
KEPENGURUSAN 2016/2017
Nama :...........................................
Kelas :............................................
No Hp :............................................
Tempat Tanggal Lahir :...........................................
Jenis Kelamin :...........................................
Agama :...........................................
Alamat :............................................
Nama Orang Tua : Ayah :................................ Ibu :................................ ......
No Hp : Ayah :................................ Ibu : .....................................
Pekerjaan : Ayah : ............................... Ibu : ....................................
Hobbi : ................................................................................ ......... ... ..
Alat Musik Yang Bisa Dimainkan :....................................................................... .......... ......
..................................................................................................................................................
Seni Yang Di Minati :...............................................................................................................
......................................................................................................................................................
Pentas Seni Yang Sudah Dimainkan:......................................................................................
.....................................................................................................................................................
Sanggar Seni Yang Pernah Di ikuti:.......................................................................................
....................................................................................................................................................
Alasan Masuk Ke Sanggar Seni Potes:..................................................................................
.....................................................................................................................................................
Kendari,....................................2016
Peserta,
........................................................
FOTO GAYA BEBAS
UKURAN 4 X 6
(UKURAN DOMPET)

2. NAMA-NAMA PESERTA
DIKLAT STATER “POTES “
SMA NEGERI 2 KENDARI
NOMOR NAMA KELAS
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