YAYASAN AL-FALAH AL-ISLAMIYYAH CILACAP

SMK FATAHILLAH CIPARI

Jl. KH. Ahmad Dahlan No.01, Desa Cipari Kecamatan Cipari
Kabupaten Cilacap Jawa Tengah, Kode Pos 53262, Telp. (0280) 6226225
@-mail : smkfatahillah@yahoo.co.id

BIODATA SISWA KEGIATAN PRAKERIN TAHUN PELAJARAN 2017/2018

SMK FATAHILLAH CIPARI

DATA PRIBADI :

Nama Lengkap : .........................................................................................................................

No induk siswa (NIS) : .........................................................................................................................
Tempat tanggal lahir : .........................................................................................................................
Jenis kelamin : .........................................................................................................................
Agama : .........................................................................................................................
Alamat : .........................................................................................................................
Kelas : .........................................................................................................................
Golongan darah : .........................................................................................................................
Anak ke : ............... Dari : ........... Saudara
Tinggi badan : ............... Cm Berat badan : ............. Kg
No. HP : .........................................................................................................................
Tempat prakerin : .........................................................................................................................
Kelas prakerin : A) Regular B) Industri (pilih salah satu).

DATA ORANG TUA :

Nama Ayah : .........................................................................................................................

Umur : .........................................................................................................................
Pekerjaan : .........................................................................................................................
Pendidikan : .........................................................................................................................
Alamat Lengkap : .........................................................................................................................
No. HP : .........................................................................................................................

Nama Ibu : .........................................................................................................................

Umur : .........................................................................................................................
Pekerjaan : .........................................................................................................................
Pendidikan : .........................................................................................................................
Alamat lengkap : .........................................................................................................................
No. HP : .........................................................................................................................

Keterangan :
Mohon wajib di isi untuk kepentingan data induk siswa.
 YAYASAN AL-FALAH AL-ISLAMIYYAH CILACAP
SMK FATAHILLAH CIPARI
Jl. KH. Ahmad Dahlan No.01, Desa Cipari Kecamatan Cipari
Kabupaten Cilacap Jawa Tengah, Kode Pos 53262, Telp. (0280) 6226225
@-mail : smkfatahillah@yahoo.co.id

BIODATA SISWA KEGIATAN KUNJUNGAN INDUSTRI / KI TAHUN PELAJARAN 2017/2018

SMK FATAHILLAH CIPARI

DATA PRIBADI :

Nama Lengkap : .........................................................................................................................

No induk siswa (NIS) : .........................................................................................................................
Tempat tanggal lahir : .........................................................................................................................
Jenis kelamin : .........................................................................................................................
Agama : .........................................................................................................................
Alamat : .........................................................................................................................
Kelas : .........................................................................................................................
Golongan darah : .........................................................................................................................
Anak ke : ............... Dari : ........... Saudara
Tinggi badan : ............... Cm Berat badan : ............. Kg
No. HP : .........................................................................................................................

DATA ORANG TUA :

Nama Ayah : .........................................................................................................................

Umur : .........................................................................................................................
Pekerjaan : .........................................................................................................................
Pendidikan : .........................................................................................................................
Alamat Lengkap : .........................................................................................................................
No. HP : .........................................................................................................................

Nama Ibu : .........................................................................................................................

Umur : .........................................................................................................................
Pekerjaan : .........................................................................................................................
Pendidikan : .........................................................................................................................
Alamat lengkap : .........................................................................................................................
No. HP : .........................................................................................................................

Keterangan :
Mohon wajib di isi untuk kepentingan data induk siswa.