Format Usulan Siswa Penerima Bantuan Siswa Miskin (BSM) / Program Indonesia Pint

ar (PIP) Tahun 2015

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<tr>
<td>Nama Sekolah</td><td>:</td><td>SMKS BINA NUSA SLAWI</td>
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<tr>
<td>Propinsi</td><td>:</td><td>Prop. Jawa Tengah</td>
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<tr>
<td>Kabupaten</td><td>:</td><td>Kab. Tegal</td>
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</table>

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<th>No.</th>
<th>NPSN</th>
<th>Nama Sekolah</th>
<th>Nama Siswa</th>
<th>NISN</th>
<th>Kelas</th>
<th>Jenis Kelamin</th>
<th>Tanggal Lahir</th>
<th>Nama Ibu Kandung</th>
<th>Nama Ayah</th>
<th>Nama Wali</th>
<th>Kriteria Penerima</th>
</tr>
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<td align='center'>1</td>
<td align='center'>2</td>
<td align='center'>3</td>
<td align='center'>4</td>
<td align='center'>5</td>
<td align='center'>6</td>
<td align='center'>7</td>
<td align='center'>8</td>
<td align='center'>9</td>
<td align='center'>10</td>
<td align='center'>11</td>
<td align='center'>12</td>
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<td>Mengetahui,</td>
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<td>Kepala Dinas Pendidikan</td>
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<td>Kepala Sekolah</td>
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<td>&nbsp;</td>
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<td>Kab. Tegal</td>
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<td>..............................</td>
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<td>Sunaryo</td>
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<td>..............................</td>
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<td></td>
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