BIODATA SISWA X IPS 2

Keterangan Tentang Diri Siswa

1. Nama Siswa:................................................................................................
     a.  Nama Lengkap:.......................................................................................   FOTO
     b.  Nama Panggilan:.....................................................................................   3X4
2. Tempat, Tgl Lahir:.......................................................................................
3. Jenis Kelamin:..............................................................................................
4. Agama:.........................................................................................................
5. Anak ke:………………dari……………bersaudara
6. Status dalam keluarga  :  Anak kandung / anak angkat / anak tiri
7. Anak yatim / piatu / yatim piatu  :..................................................................................
8. Bahasa Sehari-hari  :.......................................................................................................
9. Alamat:……………………………………………………………RT:……RW:…….      
Kelurahan/Desa:..............................................................................................................
Kecamatan:.....................................................................................................................
Kabupaten/Kota:.............................................................................................................
10. No. HP:...........................................................................................................................
11. Tinggal bersama:.............................................................................................................
12. Jarak Tempat Tinggal ke sekolah  :    ...... Km
13. Alat transportasi ke sekolah:...........................................................................................
14. Jalur masuk :...................................................................................................................
15. Pihak yang dihubungi  : Ayah/Ibu/Wali siswa
16. Penanggung Biaya  :  Ayah/Ibu/Wali siswa

Data Ayah
1. Nama:..............................................................................................................................
2. TTL:................................................................................................................................
3. Agama:............................................................................................................................
4. Kewarganegaraan:...........................................................................................................
5. Pendidikan Terakhir:.......................................................................................................
6. Pekerjaan:........................................................................................................................
7. Penghasilan:....................................................................................................................
8. Alamat:……………………………………………………………RT:……RW:…….      
Kelurahan/Desa:..............................................................................................................
Kecamatan:.....................................................................................................................
Kabupaten/Kota:.............................................................................................................
9. No Tlp / No. HP:.............................................................................................................

Data Ibu
1. Nama:..............................................................................................................................
2. TTL:................................................................................................................................
3. Agama:............................................................................................................................
4. Kewarganegaraan:...........................................................................................................
5. Pendidikan Terakhir:.......................................................................................................
6. Pekerjaan:........................................................................................................................
7. Pengahsilan:....................................................................................................................
8. Alamat:……………………………………………………………RT:……RW:…….      
Kelurahan/Desa:..............................................................................................................
Kecamatan:.....................................................................................................................
Kabupaten/Kota:.............................................................................................................
9. No Tlp / No. HP:.............................................................................................................

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