FORMAT IDENTITAS PESERTA DIDIK

IDENTITAS PESERTA DIDIK

1.     Nama Peserta Didik            : .............................................................................

a.      Nama Lengkap              : .............................................................................

b.     Nama Panggilan            : .............................................................................

2.     Nomor Induk                       : .............................................................................

3.     Tempat, Tanggal Lahir       : .............................................................................

4.     Jenis Kelamin                      : .............................................................................

5.     Agama                                 : .............................................................................

6.     Anak Ke                               : .............................................................................

7.     Nama Orang Tua                

a.        Ayah                             : .............................................................................

b.       Ibu                                 : .............................................................................

8.     Pekerjaan Orang Tua

a.        Ayah                             : .............................................................................

b.       Ibu                                 : .............................................................................

9.     Alamat Orang Tua              

a.        Jalan                             : .............................................................................

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

b.       Desa                              : .............................................................................

c.        Kecamatan                    : .............................................................................

d.       Kabupaten                    : .............................................................................

e.        Provinsi                        : .............................................................................

10.  Wali Peserta Didik             

a.        Nama                            : .............................................................................

b.       Pekerjaan                      : .............................................................................

c.        Alamat                          : .............................................................................

.................,   ..................................

Kepala Raudhatul Atfal

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

NIP.