FORMULIR Pendaftaran

PANITIA PELAKSANA
KIMIA OKSIGEN 2018 SE-SUMBAGSEL

HIMPUNAN MAHASISWA PENDIDIKAN KIMIA
FAKULTAS KEGURUAN DAN ILMU PENDIDIKAN
UNIVERSITAS JAMBI
Sekretariat : Gedung F Lt. I FKIP Kampus UNJA Jl. Jambi-Ma. Bulian Mendalo Darat 36361
FORMULIR PENDAFTARAN
LOMBA OLIMPIADE KIMIA TINGKAT SMA
SE-SUMBAGSEL ”KIMIA OKSIGEN 2018”
PMIPA FKIP UNIVERSITAS JAMBI
I. Asal Sekolah :
II. Data Guru Pendamping
> Nama : ________________________________________________________
> NIP : _________________________________________________________
> Alamat : _________________________________________________________
> No Hp/Telp : _________________________________________________________
> No Telp Sekolah : _________________________________________________________
III. Data Siswa / Siswi
A. Data Diri Siswa
1. Nama :__________________________________________________________
Nis :__________________________________________________________
Kelas :__________________________________________________________
2. Nama :__________________________________________________________
Nis :__________________________________________________________
Kelas :__________________________________________________________
Jambi, Desember 2017

Guru Pendamping
------------------------------------
NIP
NB: Formulir Dapat

Diperbanyak
PANITIA PELAKSANA
UNIVERSITAS JAMBI
LOMBA POSTER TINGKAT SMA
KOMPETISI KIMIA SE-SUMBAGSEL “KIMIA OKSIGEN 2018”
Nama : __________________________________________________________________
Asal Sekolah :
NIS : __________________________________________________________________
TTL : __________________________________________________________________
Jenis Kelamin : __________________________________________________________________
Agama : __________________________________________________________________
Alamat : __________________________________________________________________
__________________________________________________________________
No.Telp/Hp Siswa : __________________________________________________________________
No.Telp/Hp
Guru Pendamping : __________________________________________________________________
3X4
NIS.
NB: Formulir Dapat

Diperbanyak
PANITIA PELAKSANA
UNIVERSITAS JAMBI
LOMBA POSTER TINGKAT SMP
SE-KOTA JAMBI DAN MUARO JAMBI
Nama : __________________________________________________________________
Asal Sekolah :
NIS : __________________________________________________________________
TTL : __________________________________________________________________
Jenis Kelamin : __________________________________________________________________
Agama : __________________________________________________________________
Alamat : __________________________________________________________________
__________________________________________________________________
No.Telp/Hp Siswa : __________________________________________________________________
No.Telp/Hp
Guru Pendamping : __________________________________________________________________
3X4
NIS.
NB: Formulir Dapat

Diperbanyak
PANITIA PELAKSANA
UNIVERSITAS JAMBI
LOMBA KARYA TULIS ILMIAH TINGKAT SMA
KOMPETISI KIMIA SE-SUMBAGSEL “KIMIA OKSIGEN 2018”
Nama : __________________________________________________________________
Asal Sekolah :
NIS : __________________________________________________________________
TTL : __________________________________________________________________
Jenis Kelamin : __________________________________________________________________
Agama : __________________________________________________________________
Alamat : __________________________________________________________________
__________________________________________________________________
No.Telp/Hp : __________________________________________________________________
Nama Ketua : __________________________________________________________________
Nama Anggota : __________________________________________________________________
__________________________________________________________________
__________________________________________________________________
3X4
NIS.
NB: Formulir Dapat

Diperbanyak
PANITIA PELAKSANA
UNIVERSITAS JAMBI
FORMULIR PENDAFTARAN SEMINAR

Nama : __________________________________________________________________
TTL : __________________________________________________________________
Jenis Kelamin : __________________________________________________________________
Agama : __________________________________________________________________
Alamat : __________________________________________________________________
Pekerjaan : __________________________________________________________________
__________________________________________________________________
No.Telp/Hp : __________________________________________________________________
Email : __________________________________________________________________
3X4
NB: Formulir Dapat

Diperbanyak
PANITIA PELAKSANA
UNIVERSITAS JAMBI
FORMULIR PENGINAPAN
Nama Sekolah :
Jumlah Peserta :
Nama Guru Pendamping : 1.
2.
No. Hp : 1.
2.
Dengan biaya penginapan sebesar Rp 200.000/orang selama 2 hari 2 malam (2 kali makan
perhari serta transportasi dari penginapan ke Universitas Jambi)
Dengan ini menyatakan setuju untuk menginap.
Guru Pendamping
----------------------------------
NB: Formulir Dapat

Diperbanyak
PANITIA PELAKSANA
UNIVERSITAS JAMBI
OLIMPIADE KIMIA TINGKAT MAHASISWA
SE-PROVINSI JAMBI ”KIMIA OKSIGEN 2018”
Nama : ...................................................................................................
Tempat/Tanggal Lahir : ...................................................................................................
Jenis Kelamin : ...................................................................................................
Alamat : ...................................................................................................
...................................................................................................
Agama : ...................................................................................................
No. Hp : ...................................................................................................
Universitas : ...................................................................................................
Fakultas/Prodi : ...................................................................................................
Semester : ...................................................................................................
NIM : ...................................................................................................

Mahasiswa
3x4
------------------------------------
NIM
NB: Formulir Dapat

Diperbanyak
PANITIA PELAKSANA
UNIVERSITAS JAMBI
LOMBA POSTER TINGKAT MAHASISWA
KOMPETISI KIMIA SE-SUMBAGSEL JAMBI “KIMIA OKSIGEN 2018”
Nama : __________________________________________________________________
Asal Universitas :
Fakultas/Prodi : __________________________________________________________________
Semester : __________________________________________________________________
NIM : __________________________________________________________________
TTL : __________________________________________________________________
Jenis Kelamin : __________________________________________________________________
Agama : __________________________________________________________________
Alamat : __________________________________________________________________
__________________________________________________________________
No.Telp/Hp : __________________________________________________________________
Jambi, 2017
3X4
NIM.
NB: Formulir Dapat

Diperbanyak
PANITIA PELAKSANA
UNIVERSITAS JAMBI
LOMBA KARYA TULIS ILMIAH TINGKAT MAHASISWA
KOMPETISI KIMIA SE-SUMBAGSEL JAMBI “KIMIA OKSIGEN 2018”
I. Asal Universitas : ...................................................................................................

Fakultas/Prodi : ...................................................................................................
II. Data Dosen Pendamping
Nama : ...................................................................................................
NIP : ...................................................................................................
Alamat : ...................................................................................................
No. Hp/Telp. : ...................................................................................................
III. Data Mahasiswa
1. Nama : ...................................................................................................
NIM : ...................................................................................................
No. Hp : ...................................................................................................
Semester : ...................................................................................................
2. Nama : ...................................................................................................
NIM : ...................................................................................................
No. Hp : ...................................................................................................
Semester : ...................................................................................................
IV. Judul Karya Tulis : ...................................................................................................
3X4
NIM.
NB: Formulir Dapat

Diperbanyak
PANITIA PELAKSANA
UNIVERSITAS JAMBI
LOMBA ESSAY
Nama : __________________________________________________________________
Asal :
NIS : __________________________________________________________________
TTL : __________________________________________________________________
Jenis Kelamin : __________________________________________________________________
Agama : __________________________________________________________________
Alamat : __________________________________________________________________
__________________________________________________________________
No.Telp/Hp : __________________________________________________________________
Judul Essay : __________________________________________________________________
3X4
NB: Formulir Dapat

Diperbanyak
PANITIA PELAKSANA
UNIVERSITAS JAMBI
NB: Formulir Dapat

Diperbanyak

FORMULIR Pendaftaran

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PANITIA PELAKSANA

KIMIA OKSIGEN 2018 SE-SUMBAGSEL

Jambi, Desember 2017

NB: Formulir Dapat

Jenis Kelamin : __________________________________________________________________

No.Telp/Hp Siswa : __________________________________________________________________

Jambi, Desember 2017

NB: Formulir Dapat

Jenis Kelamin : __________________________________________________________________

No.Telp/Hp Siswa : __________________________________________________________________

Jambi, Desember 2017

NB: Formulir Dapat

Jenis Kelamin : __________________________________________________________________

Nama Ketua : __________________________________________________________________

Nama Anggota : __________________________________________________________________

Jambi, Desember 2017

NB: Formulir Dapat