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BIODATA SISWA KELAS 12 MIA-1

NAMA : ......................................................................................................

JENIS KELAMIN : ......................................................................................................

TEMPAT LAHIR : ......................................................................................................

TANGGAL LAHIR : ......................................................................................................

AGAMA : ......................................................................................................

TELP/HP : ......................................................................................................

EMAIL : ......................................................................................................

STATUS DALAM KELUARGA : ......................................................................................................

ANAK KE- : ......................................................................................................

NIS : ......................................................................................................

MADRASAH/SEKOLAH ASAL : ......................................................................................................

DITERIMA DI MAN 10 : KELAS : ..............................................................................

TANGGAL : ..............................................................................

ALAMAT : ......................................................................................................

PROPINSI : ......................................................................................................

KOTA/KABUPATEN : ......................................................................................................

KECAMATAN : ......................................................................................................

KELURAHAN : ......................................................................................................

KODE POS : ......................................................................................................

ORANG TUA

NIK AYAH : ......................................................................................................

NAMA AYAH : ......................................................................................................

TANGGAL LAHIR AYAH : ......................................................................................................

PENDIDIKAN AYAH : ......................................................................................................

PEKERJAAN AYAH : ......................................................................................................

TELP/HP AYAH : ......................................................................................................

NIK IBU : ......................................................................................................

NAMA IBU : ......................................................................................................

TANGGAL LAHIR IBU : ......................................................................................................

PENDIDIKAN IBU : ......................................................................................................

PEKERJAAN IBU : ......................................................................................................

TELP/HP IBU : ......................................................................................................

NIK WALI : ......................................................................................................

NAMA WALI : ......................................................................................................

TANGGAL LAHIR WALI : ......................................................................................................

PENDIDIKAN WALI : ......................................................................................................

PEKERJAAN WALI : ......................................................................................................

TELP/HP WALI : ......................................................................................................