SMP SWASTA KATOLIK BUDI MURNI-2

JL. KAPITEN PURBA I

MEDAN
BIO DATA
I. DATA PRIBADI
1. Nama lengkap : .......................................................................................
2. NIS/NISN : .......................................................................................
3. Tempat/tanggal lahir : .......................................................................................
4. Jenis Kelamin : .......................................................................................
5. Agama : .......................................................................................
6. Status Keluarga : ........................................................................................
7. Anak Ke : ..........................dari.....................bersaudara.
8. Asal Sekolah : .......................................................................................
9. Cita-cita : .......................................................................................
10. Hobby : .......................................................................................
11. No. HP. Pribadi : .......................................................................................
12. Alamat Lengkap : .......................................................................................
.......................................................................................
II. DATA AYAH
1. Nama lengkap : .......................................................................................
2. Tempat/tanggal lahir(Usia) : .......................................................................................
3. Pendidikan Terakhir : .......................................................................................
4. Fakultas dan Jurusan : .......................................................................................
5. Pekerjaan : .......................................................................................
6. Unit Kerja : .......................................................................................
7. Alamat Kerja : .......................................................................................
8. No. HP : .......................................................................................
9. Penghasilan : .......................................................................................

III. DATA IBU

1. Nama lengkap : .......................................................................................
2. Tempat/tanggal lahir (Usia) : .......................................................................................
3. Pendidikan Terakhir : .......................................................................................
4. Fakultas dan Jurusan : .......................................................................................
5. Pekerjaan : .......................................................................................
6. Unit Kerja : .......................................................................................
7. Alamat Kerja : .......................................................................................
8. No. HP : .......................................................................................
9. Penghasilan :
IV. DATA WALI
1. Nama lengkap : .......................................................................................
2. Pekerjaan : .......................................................................................
3. Hubungan keluarga : .......................................................................................
4. Alamat Kerja : .......................................................................................
5. No. HP : .......................................................................................

Medan, Juli 2019

Ayah Ibu Siswa

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