LEMBAR DATA SISWA

Melampirkan Fotocopy KK dan Akte Anak

A. KETERANGAN SISWA
1. Nama Murid
a. Lengkap : Kanya Ardellia Shidqi.................................................................
b. Panggilan : Kanya..........................................................................................
2. Jenis Kelamin : Laki – Laki/ Perempuan
3. Kelahiran
a. Tanggal Lahir : 25 November 2014.......................................................................
b. Tempat Lahir : Bekasi...........................................................................................
4. Agama : Islam.............................................................................................
5. Kewarganegaraan : Indonesia
6. Anak Ke : 2 (Dua)...........................................................................................
7. Jumlah Saudara : 2 ( Dua)..........................................................................................
a. Kandung
b. Tiri
c. Angkat
8. Bahasa sehari – hari dirumah : Indonesia
9. Golongan Darah : AB..................................................................................................
10. Alamat saat diterima :Perum Trevista Residence ...............................................................
a. RT / RW : 04 / 029...........................................................................................
b. Desa / Kelurahan : Kebalen...........................................................................................
c. Kecamatan : Babelan...........................................................................................
d. Kabupaten / Kota : Bekasi.............................................................................................
e. Provinsi : Jawa Barat
11. Kode Pos : 17160..............................................................................................
12. No. Tlp : 085880001187.................................................................................
13. Bertempat tinggal pada : Orang Tua
14. Jarak Ke Sekolah : 6,5 km..............................................................................................
15. Berat Badan : 35..... Kg
16. Tinggi Badan : 120... Cm

B. KETERANGAN ORANG TUA/ WALI PESERTA DIDIK

17. Nama Orang Tua Kandung
a. Ayah : Fadjar Trihandoyo............................................................................
b. Ibu : Tri Puji Asih.....................................................................................
18. Pendidikan Terakhir
a. Ayah : S1.....................................................................................................
b. Ibu : SMK.................................................................................................
19. Pekerjaan Orang Tua
a. Ayah : Karyawan Swasta..............................................................................
b. Ibu : IRT....................................................................................................

C. PERKEMBANGAN PESERTA DIDIK

20. Pendidikan Sebelumnya : TK/ Bimba/ Tidak TK
a. Masuk Menjadi Peserta Didik Baru : Ya
1) Asal Sekolah : TK AL-Bina.................................................................
2) Nama Sekolah : TK AL-Bina.................................................................
b. Tanggal dan Nomor Ijazah / STTB : ........................................................................................
c. Pindahan dan Sekolah Lain
1) Nama Sekolah Asal : ........................................................................................
2) Dari Tingkat : ........................................................................................
3) Diterima Tanggal : ........................................................................................
4) No. Surat Keterangan : ........................................................................................