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MPLS - Pendataan Siswa SMK Negeri 1 Mojokerto
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Nama Lengkap
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Jenis kelamin
Laki-Laki
Perempuan
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KELAS
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X DPIB 1
X DPIB 2
X DPIB 3
X TKRO 1
X TKRO 2
X TKRO 3
X TBSM 1
X TBSM 2
X TBSM 3
X TKJ 1
X TKJ 2
X TKJ 3
X MM 1
X MM 2
X MM 3
NISN
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NIK
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Tempat Lahir
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Tanggal Lahir
MM
/
DD
/
YYYY
No Registasi Akta Lahir
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Agama & Kepercayaan
ISLAM
KATOLIK
PROTESTAN
HINDU
BUDHA
KONGHUCU
Other:
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Kewarganegaraan
INDONESIA
ASING
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Alamat Rumah
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RT
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RW
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Nama Dusun
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Nama Kelurahan/ Desa :
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Kecamatan
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Kode Pos
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Latitude
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Longitude
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Tempat Tinggal
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Bersama Orang tua
Wali
Kos
Asrama
Panti Asuhan
Lainnya
Moda Transportasi
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Nomor KKS :(Kartu Keluarga Sejahtera)
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Anak ke-berapa :(berdasarkan KK)
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Penerima KPS/PKH
Ya
Tidak
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Apakah Punya KIP?
Ya
Tidak
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Nomor KIP
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Nama tertera di KIP
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Alasan layak KIP/PIP
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Nama Bank
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No Rekening
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Kantor Cabang Pembantu :(KCP)
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Rekening atas nama
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Nama ayah Kandung
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NIK Ayah
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Tgl Lahir Ayah
MM
/
DD
/
YYYY
Pendidikan Ayah
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SD
SMP
SMA/SMK
D1
D3
S1/D4
S2
S3
Pekerjaan Ayah
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Penghasilan Ayah
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Bekebutuhan Khusus
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Nama ibu Kandung
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NIK Ibu
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Tgl Lahir Ibu
MM
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DD
/
YYYY
Pendidikan Ibu
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SD
SMP
SMA/SMK
D1
D3
S1/D4
S2
S3
Pekerjaan Ibu
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Penghasilan Ibu
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Bekebutuhan Khusus
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Nama Wali Murid
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NIK Wali Murid
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Tgl Lahir Wali Murid
MM
/
DD
/
YYYY
Pendidikan Wali Murid
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SD
SMP
SMA/SMK
D1
D3
S1/D4
S2
S3
Pekerjaan Wali Murid
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Penghasilan Wali Murid
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Nomor telepon Rumah
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Nomor HP
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Email
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Tinggi Badan (cm)
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Berat Badan (kg)
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Jarak tempat tinggal ke sekolah (m)
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Waktu Tempuh ke sekolah (Jam : Menit)
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Jumlah Saudara Kandung
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Jenis Prestasi
Akademik
Non Akdemik
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Tingkat Prestasi
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Kota/Kab
Provinsi
Nasional
Internasional
Nama Prestasi
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Tahun Prestasi
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Penyelenggara
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Peringkat
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Jenis beasiswa
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Keterangan
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Tahun Mulai
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Tahun Selesai
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Kompetensi Keahlian
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DPIB
TKRO
TBSM
TKJ
MM
Jenis Pendaftaran
Siswa Baru
Pindahan
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Tanggal Masuk Sekolah
*
MM
/
DD
/
YYYY
Asal Sekolah
*
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Nomor Peserta Ujian Nasional
*
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No. Seri SKHUS
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