Nama : .....................................................................................
Tempat dan Tanggal Lahir : .....................................................................................
Nomor Induk : .....................................................................................
Nomor Induk Siswa Nasional : .....................................................................................
Paket Keahlian : Teknik Pengelasan
Kelompok C
1. Fisika
2. Kimia
3. Gambar Teknik
4. Simulasi Digital
5. Dasar Program Keahlian
6. Paket Keahlian
Rata-rata
……..........................,..............................., 2017
Kepala Sekolah,
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NIP ....................................................................