FORMULIR ISIAN DATA SISWA

DATA SISWA DATA ORANG TUA/WALI *)

Nama Lengkap : Nama Orang Tua/Wali *) :
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Tempat Lahir : .............................................................................. Tanda Pengenal : KTP Paspor

SIM
Tanggal Lahir :
No ......................................................................
Jenis Kelamin :
Hubungan dengan Siswa : ............................................................................
Nama Ibu Kandung : ..............................................................................
Alamat Rumah : ............................................................................
Alamat Tempat Tinggal : ..............................................................................
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No. Telp. Rumah :
No. Telp. Rumah :
No. HP :
No. HP :
Alamat e-mail (jika ada) : ..............................................................................

Tanda Pengenal : NISN NIK Pekerjaan : Ibu Rumah Tangga TNI/POLRI

NIS Akte Kelahiran Wirausaha BUMN/BUMD

No ........................................................................ Pegawai Negeri Profesional

Pegawai Swasta Lainnya ..........................
Tingkat Pendidikan : PAUD TK SD/Sederajat
SMP/Sederajat SMA/Sederajat Nama Perusahaan/Instansi Tempat Bekerja :
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DATA SEKOLAH
Alamat Kantor : .........................................................................................

Nama Sekolah : ......................................................................................... ...........................................................................................................................

Alamat Sekolah : ......................................................................................... ...........................................................................................................................

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No. Telepon : Jabatan (bila ada) : .........................................................................................

Diisi oleh Sekolah Orang Tua/Wali,

Data telah lengkap dan telah diveri kasi

Petugas Sekolah:

Orang Tua/Wali