BIODATA SISWA

KELAS : XI RPL

1. Nama Lengkap : .........................................................................................................................

2. Nama Panggilan : .........................................................................................................................
3. Tempat / Tanggal Lahir : .........................................................................................................................
4. Jenis Kelamin : .........................................................................................................................
5. Agama : .........................................................................................................................
6. Status dalam Keluarga : .........................................................................................................................
7. Jumlah Tanggungan Orang tua :............................Anak ke....................dari...........
8. Alamat Siswa : .........................................................................................................................
.........................................................................................................................
9. Nomor Telepon / HP : .........................................................................................................................
10. Asal Sekolah :
a. Nama Sekolah : .........................................................................................................................
b. Jumlah Nem : .........................................................................................................................

11. Ayah :
a. Nama Ayah : .........................................................................................................................
b. Pekerjaan : .........................................................................................................................
c. Nomor Telepon / Hp: .........................................................................................................................
d. Penghasilan : A. Kurang dari 1 juta B. Antara 1 Juta sampai 3 juta C. Lebih dari 3 juta

12. Ibu :
a. Nama Ibu : .........................................................................................................................
b. Pekerjaan : .........................................................................................................................
c. Nomor Telepon / Hp: .........................................................................................................................
d. Penghasilan : A. Kurang dari 1 juta B. Antara 1 Juta sampai 3 juta C. Lebih dari 3 juta

13. Wali :
a. Nama Wali : .........................................................................................................................
b. Pekerjaan : .........................................................................................................................
c. Nomor Telepon / HP: .........................................................................................................................
d. Penghasilan : A. Kurang dari 1 juta B. Antara 1 Juta sampai 3 juta C. Lebih dari 3 juta

14. Status Tempat Tinggal Keluarga : A. Milik Sendiri B. Kontrak C. Numpang

Mengetahui orang tua / wali Jakarta, Juli 2014

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