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Form Pemilihan Peminatan
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Identitas Peserta Didik
Nama Peserta Didik
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Isi nama lengkap kamu sesuai Ijazah/Akte Kelahiran
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Sekolah Asal
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Isi sesuai sekolah asal kamu misal "SMP Negeri 1 Bekasi/SMP Ananda"
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NISN
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Tempat lahir
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Tanggal lahir
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MM
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DD
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YYYY
Jenis Kelamin
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Laki-laki
Perempuan
Agama
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Islam
Kristen
Katolik
Hindu
Budha
Konghucu
Kepercayaan
Alamat
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Telp./HP
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Email aktif
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Nama orang tua/wali
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