FORMULIR DATA DIRI

1. Nama Anak : …………………………………………………….

2. Tempat/ tanggal lahir : …………………………………………………….
3. Usia : …………………………………………………….
4. Riwayat pendidikan
a. SD : …………………………………………………………………….
b. SMP : …………………………………………………………………….
c. SMA : …………………………………………………………………….
5. Hobby : …………………………………………………………….............
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6. Prestasi yang pernah dicapai : …………………………………………….
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7. Alamat rumah : …………………………………………………………….
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8. Identitas Orangtua:
a. Nama Ayah : .................................................................................
Pendidikan Ayah : .................................................................................
Pekerjaan Ayah : .................................................................................
Alamat : .................................................................................
b. Ibu : .................................................................................
Pendidikan Ibu : .................................................................................
Pekerjaan Ibu : .................................................................................
Alamat : .................................................................................
9. Data saudara kandung :
a. Kakak : …………………………………………………………………..
b. Adik : ………………………………………………………………
10. Riwayat tes :
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