FORMULIR DATA SISWA KELAS VII A

MTS NEGERI 3 SUBANG

TAHUN AJARAN 2016 / 2017

Nama Lengkap : ...................................................................................................................

Jenis Kelamin : ...................................................................................................................
Tempat dan Tgl Lahir : ...................................................................................................................
Alamat Lengkap : ...................................................................................................................
: ...................................................................................................................
: ...................................................................................................................
Tinggal Bersama (Lingkari Salah Satu)
a. Orangtua
b. Wali
c. Kost (Ponpes)
d. .............................................
Nama Orangtua
a. Ayah : ...................................................................................................................
b. Ibu : ...................................................................................................................
Pekerjaan Orangtua
a. Ayah : ...................................................................................................................
b. Ibu : ...................................................................................................................
Transportasi Kesekolah (Lingkari salah satu)
a. Angkutan Umum
b. Ojek
c. Sepeda
d. Kendaraan Pribadi
e. ......................................................

No Hp (Wajib) : .................................................................................................................

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Catatan :
Wajib Membawa Misting dan Botol Minum Setiap hari
Atribut dan Seragam Lengkap
Meminta Izin jika peserta didik Tidak Hadir / Tidak masuk sekolah dengan surat atau Via Telp
No Hp. 083816947733 a/n Falah Hardiansyah, S.Pd (Wali kelas)

Orangtua/ Wali

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