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FORMAT S1 NOMOR STATISTIK SEKOLAH : 101 241309 007NP :

NAMA SEKOLAH : SD INPRES LOLA RAMOSTATUS SEKOLAH : INPRES

ALAMAT SEKOLAH : LOLA RAMODESA : WAIMANGURAKECAMATAN : WEWEWA BARATKABUPATEN : SUMBA BARAT DAYAPROPINSI : NUSA TENGGARA TIMUR

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FORMULIR PENDAFTARAN SISWA BARUTAHUN PELAARAN : 2014 ! 201"

A# KETERANGAN SISWA :1# N$%$ L&'()$* :

++++++++++++++++++++++2# N$%$ P$'((,$' :

++++++++++++++++++++++3# &',. K&$%,' :

+++++++++++++++++++++++4# T&%*$/ T$'(($ L$, :

+++++++++++++++++++++++"# A($%$ :

+++++++++++++++++++++++# K&$($'&($$$' :

+++++++++++++++++++++++7# A'$) K& :

+++++++++++++++++++++++# 5%$ S$56$$ K$'65'( :

+++++++++++++++++++++++9# 5%$ S$56$$ T,, :

+++++++++++++++++++++++10#5%$ S$56$$ A'()$/ :

+++++++++++++++++++++++11#B$$.$ S&$, $, :

+++++++++++++++++++++++12#B&$/ B$6$' :

++++++++++++++++++++++##

13#T,'((, B$6$' :++++++++++++++++++++++##

14#G88'($' D$$ :

+++++++++++++++++++++++1"#P&'$),/ B&$/ $'( *&'$ 6, 6&,/$ :

+++++++++++++++++++++++1#A$%$/ T&%*$/ T,'(($ :

+++++++++++++++++++++++17#B&/&%*$/ T,'(($ *$6$ 8$'( /5$ ! $, :

++++++++++++++++++++++##B# ORANG TUA ! WALI :

1# N$%$ : A$ K$'65'( :++++++++++++++++++++++#

I;5 K$'65'( :+++++++++++++++++++++##

19#P&'6,6,)$' T&/,'((,A$ K$'65'( :

+++++++++++++++++++++++I;5 K$'65'( :

++++++++++++++++++++++##20#P&)&

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I;5 K$'65'( :+++++++++++++++++++++++

21#N$%$ W$, S,.$22#P&'6,6,)$' T&/,'((,23#H5;5'($' T&$6$* A'$)24#P&)&

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Karolina Daido Ballu, S. Pd

NIP : 1931123 19409 2 001

CATATAN :