Buku induk
- 1. DATA PRIBADI SISWA BARU TAHUN PELAJARAN 2014/2015 A. KETERANGAN TENTANG NAMA DIRI SISWA NO. Pendaftaran : 1. Nama Siswa : .......................................................................................................... a. Nama Lengkap : .......................................................................................................... b. Nama Panggilan : .......................................................................................................... 2. Jenis Kelamin : .......................................................................................................... 3. Tempat Tinggal Lahir : .......................................................................................................... 4. Agama : .......................................................................................................... 5. Kewarganegaraan : .......................................................................................................... 6. Anak Keberapa : .......................................................................................................... 7. Jumlah Saudara Kandung : .......................................................................................................... 8. Jumlah Saudara Tiri : .......................................................................................................... 9. Jumlah Saudara Angkat : .......................................................................................................... 10. Anak Yatim/Piatu/Yatim Piatu : .......................................................................................................... 11. Bahasa Sehari-hari : .......................................................................................................... B. KETERNGAN TEMPAT TINGGAL SISWA 12. Alamat : .......................................................................................................... .......................................................................................................... 13. Namor Telepon : .......................................................................................................... 14. Tinggal Dengan Orang tua/saudara : .......................................................................................................... Di Asrama/Kost : .......................................................................................................... 15. Jarak Tempat Tinggal ke Sekolah : .......................................................................................................... C. KETERANGAN KESEHATAN 16. Golongan Darah : .......................................................................................................... 17. Penyakit yang Pernah diDerita : ................................................................................. ......................... TBC/Cacar/Malaria dan Lain-lain : .......................................................................................................... 18. Kelainan Jasmani : .......................................................................................................... 19. Tinggi dan Berat Badan : .......................................................................................................... D. KETERANGAN PENDIDIKAN 20. Pendidikan Sebelumnya : .......................................................................................................... a. Lulusan dari : .......................................................................................................... b. Tanggal dan Nomor STTB : .......................................................................................................... c. Lama belajar : .......................................................................................................... 21. Pindahan a. Dari Sekolah : .......................................................................................................... b. Alasan : .......................................................................................................... 22. Diterima di Sekolah ini : .......................................................................................................... a. Di tingkat : .......................................................................................................... b. Kelompok : .......................................................................................................... c. Jurusan : .......................................................................................................... d. Tanggal : .......................................................................................................... E. KETERANGAN TENTANG AYAH KANDUNG 23. Nama : .......................................................................................................... 24. Tempat Tanggal Lahir : .......................................................................................................... 25. Agama : .......................................................................................................... 26. Kewarganegaraan : .......................................................................................................... 27. Pendidikan : .......................................................................................................... 28. Pekerjaan : .......................................................................................................... 29. Penghasilan Perbulan : .......................................................................................................... 30. Alamat Rumah/Nomor Telepon : .......................................................................................................... 31. Masih Hidup/Meninggal Dunia Tahun : ..........................................................................................................
- 2. F. KETERANGAN TENTANG IBU KANDUNG 32. Nama : .......................................................................................................... 33. Tempat Tanggal Lahir : .......................................................................................................... 34. Agama : .......................................................................................................... 35. Kewarganegaraan : .......................................................................................................... 36. Pendidikan : .......................................................................................................... 37. Pekerjaan : .......................................................................................................... 38. Penghasilan Perbulan : .......................................................................................................... 39. Alamat Rumah/Nomor Telepon : .......................................................................................................... 40. Masih Hidup/Meninggal Dunia Tahun : .......................................................................................................... G. KETERANGAN TENTANG WALI 41. Nama : .......................................................................................................... 42. Tempat Tanggal Lahir : .......................................................................................................... 43. Agama : .......................................................................................................... 44. Kewarganegaraan : .......................................................................................................... 45. Pendidikan : .......................................................................................................... 46. Pekerjaan : .......................................................................................................... 47. Penghasilan Perbulan : .......................................................................................................... 48. Alamat Rumah/Nomor Telepon : .......................................................................................................... H. KEGEMARAN SISWA 49. Kesenian : .......................................................................................................... 50. Olahraga : .......................................................................................................... 51. Kemasyarakatan/Organisasi : .......................................................................................................... 52. Lain-lain : .......................................................................................................... I. KETERANGAN PERKEMBANGAN SISWA 53. Menerima Bea Siswa : Tahun.......................... s.d...........................dari.......................... : Tahun..........................s.d............................dari.......................... : Tahun..........................s.d...........................dari.......................... 54. Meninggalkan Sekolah : .......................................................................................................... a. Tanggal meninggalkan Sekolah : .......................................................................................................... b. Alasan : .......................................................................................................... 55. Akhir Pendidikan : .......................................................................................................... a. Tamat Belajar : .......................................................................................................... b. STTB Nomor : .......................................................................................................... Mengetahui, Orang tua/Wali (.................................) ......................, ......... 2014 Siswa (......................................) Catatan: 1. Lampirkan photo kopi KK (Kartu Keluarga) 2. Lampuiran photo kopi KPS (Kartu Penjamin Sosial) jika ada. 3. Lampuiran photo kopi Piagam Prestasi jika ada