buku induk smk

A. KETERANGAN PRIBADI

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

11.

12.

Nama Peserta Didik

- Nama Lengkap

- Nama Panggilan

Jenis Kelamin

Tempat Lahir

Tanggal Lahir

A g a m a

Kewarganegaraan

Anak ke berapa

Jumlah Saudara Kandung

Jumlah Saudara Tiri

Jumlah Saudara Angkat

Anak yatim/piatu/yatim piatu

Bahasa sehari-hari di rumah

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B. KETERANGAN

13.

14.

15.

Alamat

Nomor Telepon

Tempat Tinggal tersebut adalah

:

:

:

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....................................................................................................................................

pada orang tua kandung

pada seseorang dengan hubungan keluarga

menumpang pada orang lain

asrama........................................................................................................

bagi.............................................................................................................

16.

17.

Jarak dari tempat tinggal ke sekolah

Ke sekolah dengan kendaraan

berjalan kaki

:

:

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C. KETERANGAN KESEHATAN

Cap tiga jari tengah tangan kiridiatas pas foto bagian bawahwaktu meninggalkan sekolah.

Pas Foto

18.

19.

Berat Badan

Tinggi badan

......................................

......................................

......................................

......................................

Pada waktu terimaPada waktu

Meninggalkan sekolah

20.

21.

Golongan darah

Penyakit yang pernah diderita (contoh TBC, cacar dan lain-lain...............)

: .....................................................

Nomor

UrutJenis Penyakit Kelas Tahun Lama Sakit Keterangan

LEMBAR BUKU INDUK SISWA SMK

Nama Peserta Didik

NIS / NISN

Nama Sekolah

Alamat Sekolah

Kompetensi Keahlian

:

:

:

:

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.........................................................Cap tiga jari tengah tangan kiridiatas pas foto bagian bawahwaktu meninggalkan sekolah.

Pas Foto

22. Kelamin Jasmaniah / lainnya : ....................................................................................................................................

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D. KETERANGAN PENDIDIKAN SEBELUMNYA23.

24.

Asal Sekolah

a. Tanggal dan Nomor STTB

- Tanggal dan Nomor STTB

- Lama Belajar

b. SLTP lainnya

- Tanggal dan Nomor STTB

- Lama Belajar

a. Pindah dari sekolah

- Diterima disekolah ini

b. Alasan Pindah

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....................................................20.............di kelas...................................................

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E. KETERANGAN TENTANG ORANG TUA KANDUNG

No. Orang Tua Kandung Ayah Ibu

25.

26.

27.

28.

29.

30.

31.

Nama

Tempat Tanggal Lahir

Kewarganegaraan

Ijazah Terakhir

Pekerjaan

Penghasilan / bulan

Alamat

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F. KETERANGAN TENTANG WALI

No. Wali Laki - Laki Perempuan

32.

33.

34.

35.

36.

Nama

Ijazah Terakhir

Pekerjaan

Penghasilan / bulan

Alamat

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G. KETERANGAN TENTANG WALI

37.

38.

Intelegensi (IQ)

Aspek Kepribadian

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(berdasarkan tes pada tanggal................................bulan............................................

tahun...........................................................................................................................

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No. Aspek yang dinilai Semester Semester Semester Semester Semester Semester Semester Semester Semester

B C K B C K B C K B C K B C K B C K B C K B C K B C K

1.

2.

3.

4.

5.

6.

Disiplin / Ketertiban

Prakarsa / Kreativitas

Tanggung Jawab

Penyesuaian

Kemantapan Emosi

Kerjasama

39. Bakat khusus dan prestasi yang menonjol dalam

No. SMTH / TH Kesenian OlahragaKemasyarakatan

OrganisasiHasta Karya Karya Tulis

1.

2.

3.

1.

4.

5.

6.

7.

8.

H. KETERANGAN KEHADIRAN40. Jumlah hari kehadiran tiap semester :

Semester / Kls HadirTidak Hadir Karena

Sakit Ijin Alpa

Jumlah Hari Belajar

Efektif

Semester......./ Kls......

Semester......./ Kls......

Semester......./ Kls......

Semester......./ Kls......

Semester......./ Kls......

Semester......./ Kls......

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I. KETERANGAN SEKITAR PERKEMBANGAN PESERTA DIDIK

41.

42.

Tahun Masuk / terdaftar

Prestasi peserta didik

:

:

....................................................................................................................................

....................................................................................................................................

Tahun

PelajaranKelas Smt.

Program

Umum

Jumlah

Mat Pel

Nilai

Rata2

Peringkat

Kelas/

Rangking

KhususNilai

Rata2

Nilai

Tinggal

Kelas

20...../20......

20...../20......

20...../20......

43.

44.

45.

Tahun meninggalkan sekolah

dengan alasan

Pindah sekolah ke

Melanjutkan pendidikan ke

:

:

:

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J. PENERIMAAN SISWA

Tahun : ................................................................ dari : ..........................................................................................

Tahun : ................................................................ dari : ..........................................................................................

Tahun : ................................................................ dari : ..........................................................................................