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Format : 15 Nomor Statistik Sekolah

1 0 1 0 5 0 6 0 1 0 3 0

NAMA SEKOLAH : SDN Latsari III / 30

STATUS SEKOLAH : SD. Inpres

ALAMAT SEKOLAH : Jln. P. Diponegoro No. 78 Telp. (0356) 324053

DESA / KELURAHAN *) : LatsariKECAMATAN : Tuban

KAB / KODIA DATI II *) : Tuban

PROPINSI DATI I : Jawa Timur

DAFTAR CALON PESERTA EBTA / EBTANAS

TAHUN PELAJARAN : 2003 / 2004

NOMORNAMA CALON PESERTA

JENIS

KELAMIN TEMPAT DAN

TANGGAL LAHIR

NAMA AYAH

KANDUNGUrt. Induk EBTA L P

1 2 3 4 5 6 7 8

1 1195 Febby Sugiasri Eka Magdalena - P Tuban, 18-02-1991 Sugeng

2 1226 Yunita Diah Ernawati - P Tuban, 03-02-1991 Nurhadi

3 1247 Adhie Purna Kestara L - Cimahi, 20-10-1992 Sutadi

4 1249 Ahmad Hasan Arif L - Tuban, 31-01-1992 Achmad Sibawaih

5 1250 Amalia Marufa - P Tuban, 15-10-1991 Umaris

6 1251 Amy Novarina Lorensia - P Tuban, 24-11-1991 Aji Nuratim

7 1253 Arry Wahyuhidayat L - Tuban, 29-01-1992 Agus Wahyudi8 1254 Budi Utomo L - Tuban, 11-06-1991 Anjar Prabowo

9 1255 Budi Yuono L - Jombang, 26-05-1991 Nasori

10 1256 Cahya Fajar Timur Amboina L - Tuban, 16-03-1992 Sutiyono

11 1258 Dewi Setyaningsih - P Tuban, 12-03-1992 Rasidan

12 1259 Erwin Hendra Kurniawan L - Tuban, 14-10-1992 Bambang Hariyono

13 1260 Fadli L - Tuban, 04-12-1991 Kanafi

14 1264 Ikaningsari - P Tuban, 01-11-1991 Warsono

15 1265 Indah Porwaningsih - P Tuban, 07-05-1991 Pudjiono

16 1266 Indra Permana L - Tuban, 10-06-1991 Ali Murdji

17 1267 Izza Himmawati - P Tuban, 30-05-1992 Jamil

18 1268 Kharisma Agustin Bahrianti - P Jember, 15-08-1991 Syaiful Bahri

19 1269 Marfian Rizky Ersanta L - Tuban, 25-01-1992 Susanto

20 1271 Mira Herlindha Jaya - P Tuban, 02-05-1992 Djoni

21 1272 Moch. Sofwan Ali Basyar L - Tuban, 30-09-1991 Saenuri

22 1275 Muhammad Choirul Anwar L - Tuban, 30-03-1991 Sadam

23 1276 Muhammad Yusuf Saputro L - Tuban, 18-12-1991 Achyak Saputro

24 1277 Natalia Bayu Nurdian S L - Malang, 25-12-1991 Adi Susanto

25 1278 Nurlailatul Fadhilah - P Tuban, 20-02-1992 Mashuri

26 1279 Nur Slamet L - Tuban, 10-12-1991 Jaelan

27 1281 Pipit Hariyanti - P Tuban, 26-09-1990 Lasminto

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28 1283 Puji Riyadi L - Tuban, 06-04-1992 Kariyono

29 1284 Qurrotuluyuun - P Tuban, 10-11-1991 H. Abdul Ghofir

30 1285 Rahmadhani Sambodo L - Tuban, 23-03-1992 Nungki Sambodo

31 1286 Ririn Kurniaisyah - P Tuban, 15-12-1991 Sumari

32 1287 R. Yusran Karima L - Tuban, 06-09-1992 R. Supriyadi Agus Djaja33 1288 Rivo Eka Risqy L - Sumenep, 27-12-1991 Acmad Taufik Iskandar

34 1290 Siti Tatqiya - P Tuban, 30-07-1991 Joko

35 1292 Siti Mardiah Ningrum - P Tuban, 17-08-1991 Dasiran

36 1294 Siti Yuli Anna - P Tuban, 18-07-1991 Matjaeni

37 1295 Sofia Rabbani - P Tuban, 01-09-1992 Akhmad Ubaidillah

38 1297 Tri Vitasari - P Tuban, 28-01-1992 Masdjito

39 1298 Tuesday Tri Wardani L - Tuban, 31-03-1993 Kasiadi

40 1299 Verawati - P Tuban, 25-11-1991 Takim

41 1300 Wahyu Laila Sakinah - P Tuban, 26-05-1992 Tumarto

42 1301 Wahyu Sukur Widodo L - Tuban, 06-06-1991 Tasmisan

43 1302 Yoga Adi Nugroho L - Tuban, 07-08-1992 Nuryono

44 1303 Zakiah - P Tuban, 08-10-1991 Sudarsono

45 1376 Setyo Jati Hidayat L - Tuban, 13-05-1992 Lestijono

46 1385 Mustika Dewi Widaretna - P Los Palos, 01-05-1992 Suparno

47 1509 Eka Nurwahyuni - P Lamongan, 18-10-1991 Supriyanto

48 3256 Arviantino Pratama L - Bondowoso, 29-01-1992 Ir. Arif Joko Sutejo

49 1588 Noerman Rizky Alfarozy L - Madiun, 29-08-1992 Didiek Eko Sudarmanto

50 1589 Finishia Jatu Vimma Artdini - P Tuban, 01-12-1991 Eko Widodo

JUMLAH 25 25

Tuban, 17 Desember 2003Mengetahui

Kepala Sekolah Guru Kelas

D r a . S A L A M A H ENDANG TRI. P, S.Pd.

NIP. : 130 590 848 NIP. : 131 190 646

Mengetahui

Pengawas TK / SD

R A D J A B , S A .

NIP. : 130 329706