Pass Foto
3x4
BIODATA SISWA
A. KETERANGAN DIRI SISWA
1. Nama Siswa
a. Nama lengkap
b. Nama panggilan
2. Jenis Kelamin
3. Tempat Tanggal Lahir
4. Agama
5. Kewarganegaraan
6. Anak keberapa
7. Jumlah saudara kandung
8. Jumlah saudara tiri
9. Jumlah saudara angkat
10. Anak yatim/piatu/yatim piatu
11. Bahasa sehari – hari
B. KETERANGAN TEMPAT TINGGAL
1. Alamat lengkap
2. Nomor Telephone
3. Tinggal dengan orang tua/ saudara/
Asrama/kost
4. Jarak dari rumah ke sekolah
C. KETERANGAN KESEHATAN
1. Golongan darah
2. Penyakit yang pernah diderita
TBC, Cacar, Malaria dsb.
3. Kelainan Jasmani
4. Tinggi dan berat tubuh
D. KETERANGAN PENDIDIKAN
1. Pendidikan sebelumnya
a. Lulusan dari
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E. KETERANGAN TENTANG AYAH KANDUNG
1. Nama Lengkap
2. Tempat tanggal Lahir
3. Agama
4. Kewarganegaraan
5. Pendidikan
6. Pekerjaan
7. Penghasilan per bulan
8. Alamat Lengkap
9. Nomor Telephone
10. Masih hidup/meninggal dunia
F. KETERANGAN TENTANG IBU KANDUNG
1. Nama Lengkap
2. Tempat tanggal Lahir
3. Agama
4. Kewarganegaraan
5. Pendidikan
6. Pekerjaan
7. Penghasilan per bulan
8. Alamat Lengkap
9. Nomor Telephone
10. Masih hidup/meninggal dunia
G. KETERANGAN TENTANG WALI
1. Nama Lengkap
2. Tempat tanggal Lahir
3. Agama
4. Kewarganegaraan
5. Pendidikan
6. Pekerjaan
7. Penghasilan per bulan
8. Alamat Lengkap
9. Nomor Telepon
10. Masih hidup/meninggal dunia
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H. KEGEMARAN SISWA
1. Kesenian : .................................................................................
2. Olah Raga : .................................................................................
3.Kemasyarakatan/Organisasi : ..................................................................................
4. Lain – lain : ..................................................................................

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Orang tua/Wali, Siswa/i

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( Nama Jelas ) ( Nama Jelas)