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IDENTITAS SISWA

BIMBINGAN BELAJAR
“MIND”

SISWA
Nama Lengkap : _______________________________________________________
Nama Panggilan : ___________________
TTL : _________________________________
Jenis Kelamin : L / P
Agama : _________________________________
Alamat Langkap : ______________________________________________________
______________________________________________________
No. Telp / Hp : __________________ / __________________
Nama Sekolah : ______________________________________
Prestasi :
1. _________________________________________________
2. _________________________________________________
3. _________________________________________________
4. _________________________________________________
5. _________________________________________________
Pengalaman Organisasi:
1. ________________________________________________
2. _________________________________________________
3. _________________________________________________
4. _________________________________________________
5. _________________________________________________
Pelajaran yang disukai:
1. _________________________________________________
2. _________________________________________________
3. _________________________________________________
4. _________________________________________________
5. _________________________________________________
Kesulitan dalam belajar:
1. ________________________________________________
2. _________________________________________________
3. _________________________________________________

ORANGTUA
Nama Orangtua : ______________________________________________________
Alamat Langkap : ______________________________________________________
______________________________________________________
No. Telp / Hp : __________________ / __________________

WALI (Jika tinggal bersama wali)


Nama Wali : ______________________________________________________
Alamat Langkap : ______________________________________________________
______________________________________________________
No. Telp / Hp : __________________ / __________________

Jakarta, ____________________

3x4 Siswa,

___________________________

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