A. Santriwati
1. Nama lengkap : -----------------------------------------------------------------------------
2. Nama Panggilan : -----------------------------------------------------------------------------
3. Tempat Tanggal Lahir : -----------------------------------------------------------------------------
4. Jenis Kelamin : -----------------------------------------------------------------------------
5. Asal Sekolah / Madrasah : -----------------------------------------------------------------------------
6. Prestasi : -----------------------------------------------------------------------------
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7. NO HP / WA : -----------------------------------------------------------------------------
8. Alamat Rumah : -----------------------------------------------------------------------------
9. Uang jajan/hari : -----------------------------------------------------------------------------
10. Penyakit yang diderita : -----------------------------------------------------------------------------
3x4
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