Contoh Kartu Pribadi Siswa

PEMERINTAH KABUPATEN ………..

DINAS PENDIDIKAN PEMUDA DAN OLAH RAGA

SD NEGERI 012 NAUMBAI

ALAMAT: …………………………………………

KARTU PRIBADI SISWA

(STUDENT CUMMULATIVE RECORD)

A.      DATA IDENTITAS SISWA

1.       NAMA SISWA                                     

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

b.   Panggilan                                                              : ...............................................................................

2.       NIS/NISN                                                                                : ...............................................................................

3.       TEMPAT/TANGGAL LAHIR                                              : ...............................................................................

4.       JENIS KELAMIN                                                                  : ...............................................................................

5.       AGAMA                                                                                  : ...............................................................................

6.       KEWARGANEGARAAN                                                     : ...............................................................................

7.       ALAMAT & NO TLPN                                                         : ...............................................................................

8.       BERTEMPAT TINGGAL PADA                                         : ...............................................................................

9.       JARAK TEMPAT TINGGAL KE SEKOLAH                   : ...............................................................................

10.   BAHASA SEHARI-HARI                                                       : ...............................................................................

B.      PENDIDIKAN

1. SEBELUMNYA

a)      Asal murid                                                           : ...............................................................................

b)      Nama taman kanak-kanak                                : ...............................................................................

c)       Alamat                                                                 : ...............................................................................

d)      Tanggal & No. STTB                                          : ...............................................................................

1.       PINDAHAN DARI SEKOLAH LAIN

a)      Nama sekolah asal                                               : ...............................................................................

b)      Dari tingkat                                                          : ...............................................................................

2.       MASUK DI SEKOLAH INI

a)      Diterima tanggal                                                  : ...............................................................................

b)      Di tingkat                                                              : ...............................................................................

C.         KELUARGA

A.      KETERANGAN ORANG TUA/WALI MURID

1.       Nama

a)      Ayah                                                                 : ...............................................................................

b)      Ibu                                                                    : ...............................................................................

2.       Pendidikan tertinggi

a)      Ayah                                                                 : ...............................................................................

b)      Ibu                                                                    : ...............................................................................

3.       Pekerjaan                                                                 

a)      Ayah                                                                 : ...............................................................................

b)      Ibu                                                                    : ...............................................................................

4.       Wali murid (jika mempunyai)

a)      Nama                                                                : ...............................................................................

b)      Hubungan keluarga                                        : ...............................................................................

c)       Pendidikan tertinggi                                      : ...............................................................................

d)      Pekerjaan                                                         : ...............................................................................

B.      STATUS DALAM KELUARGA                             : ...............................................................................

C.      JUMLAH SAUDARA                        

a)      Kandung                                                           : ...............................................................................

b)      Tiri                                                                    : ...............................................................................

c)       Angkat                                                              : ...............................................................................

D.      SOSIAL

1.       HUBUNGAN DGN TEMAN                                   : ...............................................................................

2.       HUBUNGAN DGN GURU                                      : ...............................................................................

E.       PRESTASI BELAJAR

Tahun Pelajaran	2008/2009		2009/2010		2010/2011		2011 / 2012		... / ...
	Tk/Kls		Tk/Kls		Tk/Kls		Tk/Kls		Tk/Kls
	Smtr 1	Smtr 2	Smtr 1	Smtr 2	Smtr 1	Smtr 2	Smtr 1	Smtr 2	Smtr 1	Smtr2
	NA	NR	NA	NR	NA	NR	NA	RA	NA	NR
1.       Agama
2.       Pkn
3.       B.Ind
4.       Mtk
5.       IPA
6.       IPS
7.       KTK
8.       Penjas
9.       B. Inggris
10.   Arab Melayu
11.   Jumlah Nilai
12.   Rata-rata
Lain-lain
1.       Kelakuan
2.       Kerajinan
3.       Kebersihan
Tidak Hadir :
Sakit
Izin
Lain-lain
Naik / Tidak Naik

F.          BAKAT                                                                            : ...............................................................................

G.        MINAT                                                                              : ...............................................................................

H.        KASEHATAN

a.       Berat badan                                                  : ...............................................................................

b.      Tinggi badan                                                 : ...............................................................................

c.      Golongan darah                                            : ...............................................................................

d. Penyakit yang pernah diderita                         : ...............................................................................

I.           KARIR                                                                            : ...............................................................................

J.           CITA-CITA                                                                    : ...............................................................................

K.         TES IQ                                                                             : ...............................................................................

L.          Bea siswa

          Jenis beasiswa:                                                                   : ...............................................................................

M.       Meninggalkan sekolah

1.       Tamat belajar

a.       Tahun tamat                                                 :.....................                     No. STTB    :.........................

b.      M elanjutkan ke sekolah                              :.....................                      di                 :.........................

2.       Pindah sekolah

Dari tingkat                                                                  : ...............................................................................

a.       Ke sekolah                                                     : ...............................................................................

b.      Ke tingkat                                                      : ...............................................................................

c.       Tanggal                                                          : ...............................................................................

3.       Keluar sekolah

a.       Tanggal                                                          : ...............................................................................

b.      Alasan                                                             : ...............................................................................

N.        Lain-lain

Catatan Penting                                                                   : ...............................................................................