Data Sekolah : Nama Sekolah : .................................................................................................. NPSN : ................................................................................................... Alamat Sekolah : ................................................................................................... Desa/Kelurahan :................................................................................................... Kecamatan : ................................................................................................... Kabupaten/Kota : ................................................................................................... Nama Kepala Sekolah : ................................................................................................... No HP Kepala Sekolah : ................................................................................................... Nama Ketua Komite Sekolah : ................................................................................................... No HP Ketua Komite Sekolah : ................................................................................................... Data Siswa : Nama Siswa : ................................................................................................… NISN : ................................................................................................… Tempat/Tanggal lahir : ................................................................................................… NIK : .................................................................................................... Jenis Kelamin : .................................................................................................... Kelas : .................................................................................................... Nomor HP Siswa : .................................................................................................... Data Orangtua/Wali : Nama Ayah : .........................................................…/ HP : ............................. Nama Ibu Kandung : .........................................................…/ HP : ............................. Nama Wali : .........................................................…/ HP : ............................. Alamat Orangtua/Wali : Jl.................................................. No. ....... RT...... / .......... Desa/Kelurahan : ............................................... Kec. .......................................... Kab/Kota : ............................................... Prov. ......................................... Menyatakan bahwa data di atas adalah benar untuk mengajukan beasiswa PIP Sekolah tahun 2020. Demikian surat pengajuan usulan aspirasi ini saya buat. Atas perhatian dan kerjasamanya saya ucapkan terima kasih. ….………………,………………/2020 Pemohon,