7/17/2019 Biodata

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BIODATA PESERTA SELEKSI CALON TARUNA/I STTDTAHUN AJARAN 2015 

No. Test :I. ASAL DAERAH 

a. Provinsi : ACEH

II. IDENTITAS PESERTA

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

b. Tempat/Tgl Lahir : .......................................................................................................

c. Jenis Kelamin : .......................................................................................................

d. Agama : .......................................................................................................

e. Tinggi Badan : .......................................................................................................

f. Berat Badan : .......................................................................................................

g. Alamat Domisili : ........................................................................................................

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

III. PENDIDIKAN 

a. Jenis Sekolah : ( SMA / MA / SMK )*b. Nama Sekolah : .......................................................................................................

- Tahun Lulus : .. .....................................................................................................

- Rangking : .......................................................................................................

- Nilai STTB/UAN/SKHUN:

1. Fisika : .......................................................................................................

2. Matematika : .......................................................................................................

3. Bahasa Inggris: ......................................................................................................

c. Jurusan : .......................................................................................................

IV. ORANG TUA 

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

Pekerjaan : .......................................................................................................

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

Pekerjaan : .......................................................................................................

c. Alamat Orang Tua : .......................................................................................................

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

................., ...................................2015

Calon Taruna/I STTD,

( …………………......................…………. ) *) Coret yang tidak perlu

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