BLANGKO PENGISIAN DATA EMIS

(EDUCATION MANAGEMENT INFORMATION SYSTEM)

MTs. MIFTAHUL ULUM
TAHUN AJARAN 2016/2017

NAMA :

1. NISN :...............................................................................................
2. NIK (Sesuai KK) :...............................................................................................
3. NAMA LENGKAP (Sesuai Ijasah ) :...............................................................................................
4. TTL : ...............................................................................................
5. KELAS/RANGKING : ...............................................................................................
6. ASAL SEKOLAH : ...............................................................................................
7. HOBI : ...............................................................................................
8. CITA – CITA : ...............................................................................................
9. JUMLAH SAUDARA : ...............................................................................................
10. NO.PESERTA UJIAN
/ SKHUN SEBELUMNYA SD / MI : ...............................................................................................
11. ALAMAT (Sesuai KK) :...............................................................................................
RT/RW .....................................................................................
12. TRANSPORTASI DARI RUMAH :...............................................................................................
KE MADRASAH
13. JARAK RUMAH KE MADRASAH : Km
14. NO KK : ...............................................................................................
15. NAMA AYAH : ...............................................................................................
NO. KK / KTP AYAH : ...............................................................................................
PENDIDIKAN :................................................................................................
PEKERJAAN :................................................................................................
16. NAMA IBU :................................................................................................
NO. KK / KTP IBU : ...............................................................................................
PENDIDIKAN :................................................................................................
PEKERJAAN :................................................................................................
17. PENGHASILAN ORANG TUA :................................................................................................
18. NPSN SEKOLAH SD/ MI :................................................................................................
19. NO SKHUN :................................................................................................
20. NO. IJASAH :................................................................................................
21. TOTAL NILAI UN :................................................................................................
22. TANGGAL IJASAH /KELULUSAN :................................................................................................
23. NAMA WALI (Sesuai KK) : ...............................................................................................
NO. KK / KTP WALI : ...............................................................................................
PENDIDIKAN :................................................................................................
PEKERJAAN :................................................................................................
24. STATUS TEMPAT TINGGAL :................................................................................................

Mengetahui Magersari, .......................................

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