II.

LEMBAR BUKU INDUK SISWA SMP

NOMOR INDUK SISWA : ............................. / .................................................

A. KETERANGAN TENTANG DIRI SISWA 28. Pekerjaan : ...............................................................................................

1. Nama Siswa : ............................................................................................... 29. Penghasilan per bulan : ...............................................................................................
a. Nama Lengkap : ............................................................................................... 30. Alamat Rumah/ Nomor Telpon (Hp) : ............................................................................................... Pasfoto
b. Nama Panggilan : ............................................................................................... 31. Masih Hidup/ Meninggal Dunia Tahun : ............................................................................................... 3 x 4 cm waktu
2. Jenis Kelamin : ............................................................................................... F. KETERANGAN TENTANG IBU KANDUNG masuk sekolah
3. Tempat dan Tanggal Lahir : ............................................................................................... 32. Nama : ...............................................................................................
ini
4. Agama : ............................................................................................... 33. Tempat dan Tanggal Lahir : ...............................................................................................
5. Kewarganegaraan : ............................................................................................... 34. Agama : ...............................................................................................
6. Anak Keberapa : ............................................................................................... 35. Kewarganegaraan : ...............................................................................................
7. Jumlah Saudara Kandung : ............................................................................................... 36. Pendidikan : ...............................................................................................
8. Jumlah Saudara Tiri : ............................................................................................... 37. Pekerjaan : ...............................................................................................
9. Jumlah Saudara Angkat : ............................................................................................... 38. Penghasilan per Bulan : ...............................................................................................
10. Anak Yatim / Piatu / Yatim Piatu : ............................................................................................... 39. Alamat Rumah/ Nomor Telpon (Hp) : ...............................................................................................
11. Bahasa sehari-hari di rumah : ............................................................................................... 40. Masih Hidup/ Meninggal Dunia Tahun : ...............................................................................................
B. KETERANGAN TEMPAT TINGGAL G. KETERANGAN TENTANG WALI
12. Alamat : ............................................................................................... 41. Nama : ...............................................................................................
............................................................................................... 42. Tempat dan Tanggal Lahir : ...............................................................................................
13. Nomor Telepon / Hp : ............................................................................................... 43. Agama : ...............................................................................................
14. Tinggal dengan Orang Tua/ 44. Kewarganegaraan : ...............................................................................................
Saudara/ Di Asrama/ Kost : ............................................................................................... 45. Pendidikan : ...............................................................................................
15. Jarak tempat tinggal ke sekolah : ............................................................................................... 46. Pekerjaan : ...............................................................................................
C. KETERANGAN KESEHATAN 47. Penghasilan per Bulan : ...............................................................................................
16. Golongan Darah : ............................................................................................... 48. Alamat Rumah/ Nomor Telpon (Hp) : ...............................................................................................
17. Penyakit yang pernah diderita, H. KEGEMARAN SISWA
TBC, Cacar / Malaria dan lain2 : ............................................................................................... 49. Kesenian : ...............................................................................................
18. Kelainan Jasmani : ............................................................................................... 50. Olah Raga : ...............................................................................................
19. Tinggi dan berat badan : .............................................. .......................................... 51. Kemasyarakatan / Organisasi : ...............................................................................................
D. KETERANGAN PENDIDIKAN 52. Lain - lain : ...............................................................................................
20. Pendidikan sebelumnya I. KETERANGAN PERKEMBANGAN SISWA
a. Lulus dari : ............................................................................................... 53. Menerima Bea Siswa : Tahun..................... Kelas................... dari......................
b. Tanggal dan Nomor STTB : ............................................................................................... Tahun..................... Kelas................... dari......................
c. Lama Belajar : ............................................................................................... Tahun..................... Kelas................... dari......................
21. Pindahan 54. Meninggalkan Sekolah
a. Dari Sekolah : ............................................................................................... a. Tanggal Meninggalkan Sekolah : ...............................................................................................
b. Alasan : ............................................................................................... b. Alasan : ...............................................................................................
55. Akhir Pendidikan Pasfoto
22. Diterima disekolah ini
a. Dikelas : ............................................................................................... a. Tamat Belajar : Tahun..................................................................................... 3 x 4 cm waktu
b. Program : ............................................................................................... b. STTB No : ............................................................................................... meninggalkan
c. Tanggal : ............................................................................................... J. KETERANGAN SETELAH SELESAI PENDIDIKAN sekolah ini
E. KETERANGAN TENTANG AYAH KANDUNG 56. Melanjutkan di : ...............................................................................................
23. Nama : ............................................................................................... 57. Bekerja
24. Tempat dan Tanggal Lahir : ............................................................................................... a. Tanggal Mulai Bekerja : ...............................................................................................
25. Agama : ............................................................................................... b. Nama Perusahaan/Lembaga dan Lain2 : ...............................................................................................
26. Kewarganegaraan : ............................................................................................... c. Penghasilan : ...............................................................................................
27. Pendidikan : ...............................................................................................