BORANG MAKLUMAT MURID

PENDIDIKAN KHAS INTEGRASI

SK.SOOK

A. MAKLUMAT MURID

1. NAMA :_______________________________________

2. UMUR :_______________________________________

3. NO.KAD OKU :_______________________________________

KATEGORI OKU : MASALAH PEMBELAJARAN /

PENDENGARAN / PENGLIHATAN /
FIZIKAL / LAIN-LAIN

4. NO. SIJIL LAHIR :_______________________________________

5. NO.IC :_______________________________________

6. TARIKH LAHIR :_______________________________________

7. TEMPAT LAHIR :_______________________________________

8. JANTINA :_______________________________________

9. BANGSA :_______________________________________

10. AGAMA :_______________________________________

11. UMUR :_______________________________________

12. JARAK KE SEKOLAH :_______________________________________

13. ALAMAT RUMAH :_______________________________________

________________________________________
14. ALAMAT SURAT MENYURAT :_______________________________________

________________________________________

15. NO. TEL ( RUMAH ) :_______________________________________

16. NO. TEL ( H/ P ) :_______________________________________

B. MAKLUMAT BAPA / PENJAGA

1. NAMA :_______________________________________

2. NO.KAD PENGENALAN :_______________________________________

3. TARIKH LAHIR :_______________________________________

4. JANTINA :_______________________________________

5. BANGSA :_______________________________________

6. AGAMA :_______________________________________

7. WARGANEGARA :_______________________________________

8. HUBUNGAN : ANAK KANDUNG/ ANAK ANGKAT/

ANAK YATIM/ ANAK SAUDARA

9. PEKERJAAN :_______________________________________

10. BILANGAN TANGGUNGAN :_______________________________________

11. PENDAPATAN ( RM ) :_______________________________________

12. ALAMAT RUMAH :_______________________________________

________________________________________

13. ALAMAT SURAT MENYURAT :_______________________________________

________________________________________

14. NO.TEL ( RUMAH ) :_______________________________________

 NO.TEL ( H/P ) :_______________________________________

NO.TEL MAJIKAN :_______________________________________

C. MAKLUMAT IBU

1. NAMA :_______________________________________

2. NO.KAD PENGENALAN :_______________________________________

3. TARIKH LAHIR :_______________________________________

4. JANTINA :_______________________________________

5. BANGSA :_______________________________________

6. AGAMA :_______________________________________

7. WARGANEGARA :_______________________________________

8. HUBUNGAN : ANAK KANDUNG/ ANAK ANGKAT/

ANAK YATIM/ ANAK SAUDARA

9. PEKERJAAN :_______________________________________

10. BIL. TANGGUNGAN :_______________________________________

11. PENDAPATAN ( RM ) :_______________________________________

12. NAMA/ ALAMAT MAJIKAN :_______________________________________

________________________________________

13. ALAMAT RUMAH :_______________________________________

________________________________________

14. ALAMAT SURAT MENYURAT :_______________________________________

________________________________________

15. NO.TEL ( RUMAH ) :_______________________________________

NO.TEL ( H/P ) :_______________________________________

 NO.TEL MAJIKAN :_______________________________________

SILA SERTAKAN BERSAMA:

1. 1 SALINAN KAD OKU

2. 1 SALINAN SURAT BERANAK
3. BUKU AKAUN BSN MURID
4. 1 SALINAN IC IBU
5. 1 SALINAN IC BAPA
6. 2 KEPING GAMBAR MURID
7. 1 SALINAN REKOD IMUNISASI YANG PERNAH DIAMBIL/ APA-APA
MAKLUMAT KESIHATAN ANAK YANG DISAHKAN OLEH PEGAWAI
PERUBATAN.