BIODATA PESERTA DIDIK

TAPEL : 2018 / 2019

NISN : ............................................................................... ( WAJIB DI ISI )

KETERANGAN TENTANG DIRI SISWA

1. Nama Lengkap : ...................................................................................................
2. Jenis Kelamin : ...................................................................................................
3. Tempat/Tanggal Lahir : ...................................................................................................
4. Agama : ...................................................................................................
5. Kewarganegaraan : ...................................................................................................
6. Anak Ke-Berapa : ...................................................................................................
7. Jumlah Saudara Kandung : ...................................................................................................
8. Jumlah Saudara Tiri : ...................................................................................................
9. Jumlah Saudara Angkat : ...................................................................................................
10. Anak Yatim/Piatu/Yatim Piatu : ...................................................................................................
11. Bahasa Sehari-Hari : ...................................................................................................

KETERANGAN TEMPAT TINGGAL

12. Alamat Rumah : ...................................................................................................
...................................................................................................
13. Nomor Telp./HP. : ...................................................................................................
14. Tinggal dengan Orang Tua/Saudara
Di Asrama/Kos : ...................................................................................................
15. Jarak Tempat Tinggal ke Sekolah : ...................................................................................................

KETERANGAN KESEHATAN
16. Golongan Darah
17. Penyakit yang Pernah Diderita TBC/
Cacar/Malaria dan Lain-Lain
18. Kelainan Jasmani
19. Tinggi dan Berat Badan
: ...................................................................................................
: ...................................................................................................
: ...................................................................................................
: ...................................................................................................

KETERANGAN PENDIDIKAN
20. Lulusan Dari : ...................................................................................................
21. Tanggal dan Nomor : ...................................................................................................
22. No. Ujian Nasional SMP : ...................................................................................................
23. Diterima di Sekolah ini
a. Tingkat/Kelas : ...................................................................................................
b. Prog. Keahlian/Paket Keahlian : ...................................................................................................
c. Tanggal : ...................................................................................................
KETERANGAN AYAH KANDUNG
24. Nama Ayah : ...................................................................................................
25. Tempat/Tanggal Lahir : ...................................................................................................
26. A g a m a : ...................................................................................................
27. Kewarganegaraan : ...................................................................................................
28. Pekerjaan : ...................................................................................................
29. Penghasilan Per-Bulan : ...................................................................................................
30. Alamat Rumah/No. Telp./HP. : ...................................................................................................
..................................................................................................
31. Masih Hidup/Meninggal Dunia Thn. : ...................................................................................................

KETERANGAN IBU KANDUNG

32. Nama Ayah : ...................................................................................................
33. Tempat/Tanggal Lahir : ...................................................................................................
34. A g a m a : ...................................................................................................
35. Kewarganegaraan : ...................................................................................................
36. Pekerjaan : ...................................................................................................
37. Penghasilan Per-Bulan : ...................................................................................................
38. Alamat Rumah/No. Telp./HP. : ...................................................................................................
..................................................................................................
39. Masih Hidup/Meninggal Dunia Thn. : ...................................................................................................

KETERANGAN TENTANG WALI

40. Nama Ayah : ...................................................................................................
41. Tempat/Tanggal Lahir : ...................................................................................................
42. A g a m a : ...................................................................................................
43. Kewarganegaraan : ...................................................................................................
44. Pekerjaan : ...................................................................................................
45. Penghasilan Per-Bulan : ...................................................................................................
46. Alamat Rumah/No. Telp./HP. : ...................................................................................................
..................................................................................................
47. Masih Hidup/Meninggal Dunia Thn. : ...................................................................................................

KEGEMARAN SISWA/HOBI
48. Kesenian : ...................................................................................................
49. Olah Raga : ...................................................................................................
50. Lain-Lain : ...................................................................................................

TEMPEL
FOTO 4 x 3