profile_della.docx

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  • 8/18/2019 PROFILE_DELLA.docx

    1/1

    FORM PROFILEMAN INSAN CENDIKIA

    DataPribadi

    Nomor regristasi :

    Alamat Email : [email protected]

    Passord Email : !""#"!rga

    Nama Le$g%a& Della Meidia SasmitaNama Pa$ggila$ Della

     'e$is Kelami$ Perem&(a$ )em&at La*ir 'am+i )a$ggal La*ir #,-/-#"No. )el&01P 2#!3!!"42#"Alamat )er%i$i R). / Kel(ra*a$ Pi5oa$ Kec. 'am+i L(ar KotaKa+(&ate$0Kota M(aro 'am+iPro&i$si 'am+iKeterangan Orang Tua/WaliNama Ora$g )(a

    Aya* Eri6ar7 S.Pd.I+( Desi 8ar&itaPe$didi%a$ Ora$g )(aAya* S-"I+( SDPe$g*asila$ Ora$g )(aAya* 9 5(taI+( " 5(taPekerjaan Orang Tua/WaliAya* PNSI+( Daga$g

    Alamat Ora$g )(a08ali R). / Kel(ra*a$ Pi5oa$ Kec. 'am+i L(ar KotaKa+(&ate$0Kota M(ara 'am+iProi$si 'am+iNo. )el&01&. Ora$g )(a08ali 2"!,,"39!4Data Pendaftaran

     'e$is Asal Se%ola*

    ;M)s7SMP7R>L ILMINPSN "/,"94NIS0NISN "!!/3Setela* L(l(s Ma$ I$sa$ Ce$di%ia ?

     'al(r ? Reg(ler0Prestasi01aala$ Reg(lerPili*a$ " MAN IC ........ MAN IC 'AM