BIODATA SISWA BARU
1. Nama
Lengkap :
........................................................................................
2. Jenis
Kelamin : Laki-laki /
Perempuan
3. Tempat/Tanggal
Lahir : ........................................................................................
4. Agama : Islam / Kristen
Katolik / Kristen Protestan / Hindu / Budha
5. Golongan
Darah : A / B / AB / O *
6. Alamat
Lengkap Siswa : Jalan
................................................................................
Kelurahan ....................................................................
Kecamatan
..................................................................
Kabupaten
..................................................................
Telepon:
.......................... Handphone: ........................
7. Orangtua/Wali
a.
Nama Ayah :
........................................................................................
Pekerjaan :
........................................................................................
b.
Nama Ibu :
.......................................................................................
Pekerjaan :
........................................................................................
c.
Nama Wali :
........................................................................................
Pekerjaan :
.........................................................................................
8. Alamat
Lengkap : Jalan
...............................................................................
Orang
Tua/Wali Siswa : Kelurahan/Desa
...............................................................
Kecamatan
...................................................................
Kabupaten
...................................................................
Telepon:
........................ Handphone: ...........................
9. Anak
Ke : .......................................................................................
10. Status Dalam Keluarga : Anak Kandung / Anak Tiri / Anak Angkat *
10. Status Dalam Keluarga : Anak Kandung / Anak Tiri / Anak Angkat *
Orang Tua/Wali
.....................................
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Paringin, ..... Juni 2012
Siswa Ybs
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