IDENTITAS PESERTA DIDIK

Nama Peserta
Didik

Nomor Induk

Jenis Kelamin

Tempat, Tanggal
Lahir

Agama

Alamat Peserta
Didik

Sekolah Asal

1
0

a. Nama
Sekolah

b. Alamat

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Ijazah
a. Tahun

b. Nomor

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Diterima disekolah
ini
a. Dikelas

b. Pada
tanggal

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Nama Orang Tua

a. Ayah

b. Ibu

1
1

Alamat Orang Tua

1
2

Pekerjaan Orang
Tua

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Sumedang, 19 Desember 2015
Kepala Sekolah

Dr. E. Sulyati, M.Pd.