You are on page 1of 1

DATA SISWA

1. Nama :……………………………………………………………………………………..

2. Kelas :……………………………………………………………………………………..
:……………………………………………………………………………………..
3. Nisn
:……………………………………………………………………………………..
4. Jenis kelamin :……………………………………………………………………………………..
5. Agama :……………………………………………………………………………………..

6. Anak ke- :……………………………………………………………………………………..


:……………………………………………………………………………………..
7. Jumlah saudara
:……………………………………………………………………………………..
8. Alamat rumah :……………………………………………………………………………………..
9. Jarak rumah dari sekolah :……………………………………………………………………………………..
:……………………………………………………………………………………..
10. No.tepon siswa
:……………………………………………………………………………………..
11. Asal sekolah
:……………………………………………………………………………………..
12. Cita – cita :……………………………………………………………………………………..
13. Nama ayah :……………………………………………………………………………………..
:……………………………………………………………………………………..
14. Pekerjaan ayah
:……………………………………………………………………………………..
15. Alamat ayah
:……………………………………………………………………………………..
16. No.telepon ayah :……………………………………………………………………………………..

17. Nama ibu :……………………………………………………………………………………..


:……………………………………………………………………………………..
18. Pekerjaan ibu
:……………………………………………………………………………………..
19. Alamat ibu
:……………………………………………………………………………………..
20. No.telepon ibu :……………………………………………………………………………………..

Tandatangan siswa

Purwodadi, 24 Juli 2023

(……………………………………)

You might also like