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Formulir EMIS Madrasah Aliyah Multazam
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NSN
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NIK (Sesuai KK)
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Nama Lengkap
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Tempat Lahir
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Tanggal Lahir
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MM
/
DD
/
YYYY
Hobi
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Cita-Cita
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Jumlah Saudara
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Sekolah Asal
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Nomor Peserta UN
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Nomor Seri SKHUN
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Nomor Seri Ijasah
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Alamat lengkap Sesuai KK
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Jarak Rumah Ke Sekolah
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Transportasi ke Sekolah
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Choose
1 Km
2-5 Km
6-10 KM
Nomor Kartu Keluarga (KK)
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Nama Ayah
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Pendidikan Ayah
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Pekerjaan Ayah
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No. KTP Ayah
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Nama Ibu
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Pendidikan Ibu
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Pekerjaan Ibu
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No. KTP Ibu
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Rata-rata Penghasilan Orang Tua
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No. Telepon Orang Tua/Wali
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