PENDATAAN PESERTA DIDIK PUTUS SEKOLAH
Pendataan Dinas Pendidikan Provinsi DKI Jakarta
NAMA PESERTA DIDIK
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Tempat Lahir
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Tanggal Lahir (Bln/Hr/Th)
MM
/
DD
/
YYYY
Tidak Bersekolah Sejak (Bln/Hr/Th)
MM
/
DD
/
YYYY
Alasan Tidak Bersekolah
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Nama Orang Tua/Wali
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Pekerjaan Orang Tua/Wali
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Alamat Tinggal
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Kecamatan
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NAMA (PELAPOR)
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JABATAN
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NOMOR HP / TELP. (PELAPOR)
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Nama Sekolah
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STATUS SEKOLAH
Alamat Sekolah
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Kecamatan
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Kota/Wilayah
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