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BIODATA PESERTA DIDIK BARU SMAN 1 RANGKASBITUNG TP 2018/2019
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NAMA LENGKAP
*
Your answer
NISN
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diawali dengan ketik ' contoh : '0025832060
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JENIS KELAMIN
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Choose
Laki-laki
Perempuan
SEKOLAH ASAL
*
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TANGGAL LAHIR
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MM
/
DD
/
YYYY
ANAK KE
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Choose
1
2
3
4
5
6
7
8
9
10
NOMOR INDUK KEPENDUDUKAN (NIK)
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AGAMA
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Choose
Islam
Protestan
Katolik
Hindu
Budha
lainnya
ALAMAT
*
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RT
*
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RW
*
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DUSUN/KAMPUNG
*
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KELURAHAN
*
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KECAMATAN
*
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KODE POS
*
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JENIS TINGGAL
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Choose
Bersama Orangtua
Bersama Wali
Kost
Pesantren
ALAT TRANSPORTASI
*
Choose
Angkutan Umum/bus
Sepeda Motor
Sepeda
Mobil Pribadi
Jalan kaki
NOMOR TELPON
*
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E-MAIL
isi jika memiliki
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NOMOR REGISTRASI AKTA LAHIR
jika sudah memiliki
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NOMOR SKHUN
jika sudah memiliki
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NOMOR SERI IJAZAH
jika sudah memiliki
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NOMOR PESERTA UJIAN NASIONAL SMP/MTS
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PENERIMA KPS (Kartu Pra Sejahtera)
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Ya
Tidak
NOMOR KPS
jika sudah memiliki
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TINGGI BADAN
*
dalam Centi Meter
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BERAT BADAN
*
dalam Kilo Gram
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JARAK TEMPAT TINGAL KE SEKOLAH
*
tuliskan dalam kilo meter
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WAKTU TEMPUH KE SEKOLAH
*
tuliskan dalam JAM
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JUMLAH SAUDARA KANDUNG
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TULISKAN PRESTASI
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