BIODATA CALON PESERTA DIDIK

1. Nomor Pendaftaran :......................... (Silahkan lihat di: man2mataram.sch.id)2. Nama Lengkap :................................................................................................3. Tempat dan Tangal Lahir :................................................................................................4. Nomor Induk Siswa Nasional (NISN) :................................................................................................5. Jenis Kelamin :................................................................................................6. Anak ke :................................................................................................7. Status dalam Keluarga :................................................................................................8. Alamat :................................................................................................a. Desa/Kelurahan :................................................................................................b. Kecamatan :................................................................................................c. Kabupaten/Kota :................................................................................................d. Provinsi:................................................................................................9. Nomor Telp/HP :................................................................................................10. E-mail :................................................................................................11. Sekolah/Madrasah :................................................................................................12. Nama Asal Sekolah/Madrasah :................................................................................................13. Alamat Sekolah/Madrasah :................................................................................................14. Orangtuaa. Nama Ayah :................................................................................................b. Nama Ibu :................................................................................................15. Alamat Orangtua :................................................................................................16. Nomor Telp/HP :................................................................................................17. Pekerjaan Orangtua a. Ayah :1. TNI/Polri 2. PNS 3. PNS (Dosen/Guru) 4. Swasta 5. Wirausaha 6. Petani/Buruh 7. Lainnyab. Ibu :1. TNI/Polri 2. PNS 3. PNS (Dosen/Guru) 4. Swasta 5. Wirausaha 6. Petani/Buruh 7. Ibu rumah tangga8. Lainnya

Mataram, April 2015Calon Peserta Didik

_____________________Catatan : Biodata ini bisa diserahkan langsung atau kirim melalui E-mail MAN 2 Model Mataram (info@mail.man2mataram.sch.id)