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DATA SISWA X TITL 1

1 Nama Peserta Didik (lengkap) : ........................................................................................................................


2 NIS : .......................................................................................................................
3 NISN : .......................................................................................................................
4 KELAS : .......................................................................................................................
5 Tempat, Tanggal Lahir : .......................................................................................................................
6 Jenis Kelamin : .......................................................................................................................
7 Agama : .......................................................................................................................
8 Status dalam Keluarga : .......................................................................................................................
9 Anak ke : .......................................................................................................................
10 Alamat Peserta Didik : .......................................................................................................................
.......................................................................................................................
11 Nomor Telepon Rumah : .......................................................................................................................
12 Sekolah Asal : .......................................................................................................................
13 TERIMA DI KELAS : .......................................................................................................................
14 PADA TANGGAL : .......................................................................................................................
Perihal Orang Tua
15 NAMA AYAH : .......................................................................................................................
16 NAMA IBU : .......................................................................................................................
17 ALAMAT ORANG TUA : .......................................................................................................................
.......................................................................................................................
18 Nomor Telepon Orang Tua : .......................................................................................................................
19 Pekerjaan Ayah : .......................................................................................................................
20 Pekerjaan Ibu : .......................................................................................................................
Perihal Wali
21 Nama Wali Peserta Didik : .......................................................................................................................
22 Alamat Wali Peserta Didik : .......................................................................................................................
.......................................................................................................................
23 Nomor Telepon Rumah : .......................................................................................................................
24 Pekerjaan Wali Peserta Didik : .......................................................................................................................

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