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SMADELA JAYA
PEMERINTAH KOTA KEDIRIDINAS PENDIDIKAN
SEKOLAH MENENGAH ATAS ( SMA ) NEGERI 8 KEDIRIJalan Pahlawan Kusuma Bangsa 77, Kediri 64124, (0354) 687151
Faksimili (0354) 699806, E-mail: [email protected]
DATA SISWA
KELAS : XI IA-1TAHUN PELAJARAN 2012 / 2013
I. SISWAa. Nama Lengkap : ...................................................................b. Nama Panggilan : ...................................................................c. Jenis Kelamin : ...................................................................d. Tempat, tgl. Lahir : ...................................................................e. Agama : ...................................................................f. Alamat Rumah : ...................................................................
...................................................................g. Nomor Tlp. Rumah : ...................................................................h. Nomor HP : ...................................................................i. Alamat E-mail : ...................................................................j. Jumlah Sudara anak Ke : ...................................................................
II. ORANG TUAAYAHa. Nama : ..................................................................b. Pekerjaan : ..................................................................c. Agama : ..................................................................d. Alamat Rumah : ..................................................................
..................................................................e. Nomor Tlp. Rumah : ..................................................................f. Nomor HP : ..................................................................IBUa. Nama : ..................................................................b. Pekerjaan : ..................................................................c. Agama : ..................................................................d. Alamat Rumah : ..................................................................
..................................................................e. Nomor Tlp. Rumah : ..................................................................f. Nomor HP : ..................................................................
Orang tua, Siswa yang bersangkutan,
_________________________ __________________________NIS.
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SMADELA JAYA