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* Indicates required question
Nama
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Your answer
NISN
*
Your answer
NIS
*
Your answer
Tempat Lahir
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Tanggal lahir
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MM
/
DD
/
YYYY
Jenis Kelamin
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L
P
Agama
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1. Islam
Alamat
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Kode Pos
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Telepon
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E-mail
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Your answer
Nama Ayah
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Your answer
NIK Ayah
*
Your answer
Tanggal lahir
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MM
/
DD
/
YYYY
Pendidikan
*
Your answer
Pekerjaan
*
Your answer
Nomor Telepon/HP
*
Your answer
Nama Ibu
*
Your answer
NIK Ibu
*
Your answer
Tanggal Lahir IBU
*
MM
/
DD
/
YYYY
Pendidikan Ibu
*
Your answer
Pekerjaan Ibu
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Your answer
Nomor Telepon/HP
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Your answer
Nama Wali
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Your answer
NIK wali
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Your answer
Tanggal Lahir Wali
*
MM
/
DD
/
YYYY
Pendidikan Wali
*
Your answer
Pekerjaan Wali
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Telepon HP wali
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Sekolah Asal ( Siswa)
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Status dalam Keluarga (siswa)
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Anak Kandung
Anak Tiri
Anak Angkat
Anak Ke- (siswa)
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1
2
3
4
5
Kelas Saat ini
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X MIPA1
X MIPA2
X MIPA3
X MIPA4
X MIPA5
X IPS1
X IPS2
X IPS3
X IPS4
X BAHASA
X AGAMA
X MIPA (PDCI)
XI MIPA1
XI MIPA2
XI MIPA3
XI MIPA4
XI IPS1
XI IPS2
XI IPS3
XI IPS4
XI BAHASA
XI AGAMA
XI MIPA (PDCI)
XII MIPA1
XII MIPA2
XII MIPA3
XII MIPA4
XII IPS1
XII IPS2
XII IPS3
XII IPS4
XII BAHASA
XII AGAMA
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