1. Nama Siswa : .........................................................
2. Tempat Lahir : ......................................................... 3. Tanggal Lahir : ......................................................... 4. Jenis Kelamin : ......................................................... 5. Agama : ......................................................... 6. Nama Sekolah : ......................................................... 7. Status Dalam Keluarga : ......................................................... 8. Anak Ke : ......................................................... 9. Nama Orang tua Ayah : ......................................................... Ibu : ......................................................... 10. Alamat Tinggal : ......................................................... ......................................................... 11. No. Telp. WA Orang Tua : ......................................................... 12. No. Telp. WA Siswa : ......................................................... 13. Email siswa : ......................................................... 14. Media Sosial Siswa : ................................................... F ...................................................