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Data Pribadi Siswa
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* Indicates required question
Nama Lengkap
*
Your answer
Jenis Kelamin
*
Laki-laki
Perempuan
Required
NISN
*
Your answer
NIS
Your answer
Kelas
*
9a
9b
9c
9d
9e
9f
9g
Required
NIK
*
Your answer
No KK
*
Your answer
Temapat Lahir
*
Your answer
Tanggal Lahir
*
MM
/
DD
/
YYYY
No Akte kelahiran
Your answer
Agama
*
Hindu
Islam
Kristen
Kristen /Protestan
Budha
Katholik
Required
Alamat
*
Your answer
Nama Dusun/ Banjar
*
Your answer
Nama Kelurahan/Desa
*
Your answer
Kecamatan
*
Susut
Bangli
Kintamani
Tembuku
Required
Kode Pos
Your answer
Kordinat Lintang
*
Your answer
Kordinat Bujur
*
Your answer
Tempat Tinggal
*
Bersama Orang tua
Wali
Required
Moda Trasportasi
*
Jalan Kaki
Kendaraan pribadi
angkot
Required
Anak ke
*
1
2
3
4
5
6
Required
Apakah Punya kartu KIP
*
Ya
Tidak
Required
No KIP jika memiliki
Your answer
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