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CLASS OF 2019: REGISTRATION FORM
I. Personal Information1. Full Name : ………………………………………………………………
2. Gender : ………………………………………………………………
3. Birthplace, Date of Birth : ………………………………………………………………
4. Current School : ………………………………………………………………
5. Address : ………………………………………………………………
6. Religion : ………………………………………………………………
7. Student’s Phone Number : ………………………………………………………………
8. Email : ………………………………………………………………
II. Parents Information 1. Parent’s Name : Father ……………………… Mother ……………………
2. Parent’s Job : Father ……………………… Mother ……………………
3. Parent’s Phone Number : Father ……………………… Mother ……………………
III. Semester Report Book Score
Subject SemesterI
SemesterII
SemesterIII
Semester IV
SemesterV
Average
Ilmu Pengetahun Alam (IPA)Matematika
Bahasa Inggris
AVERAGE
IV. Achievments/ Awards List:
Achievements Year Rank(1/2/3)
Scale(School/Region/Province/Nat)
....……….…………..… 2019
(…………………………………)
IPTEK - IMTAQ – ETIKA – ESTETIKA - HARMONI
Photo Warna
3 x 4
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