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Bandung Cirebon Medan

EGS Information source / Cognitive pathway

Program

Full Name

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Nick Name

Gender

Male Female

Place of Birth

Date of Birth

NISN (Nomor Induk Siswa Nasional)

Citizenship

Daily Language

Religion

Status Of Children

Child Number / Total Siblings

Full Address

Telephone

RT/RW

Postal Code

Village Office (Kelurahan)

District (Kecamatan)

History of Disease

Blood Type

Achievement

Origin of School City

Origin of School Address

School Name

Origin of School Handphone Number

FATHER

Father's Name

Place, Date of Birth

Citizenship

Daily Language

Religion

Full Address

Telephone Number

Handphone Number

Degree

Employment

Business Fields

Employment Position

Income

Office Telephone

MOTHER

Mother's Name

Place, Date of Birth

Citizenship

Daily Language

Religion

Full Address

Telephone Number

Handphone Number

Degree

Employment

Business Fields

Employment Position

Income

Office Telephone

GUARDIAN

Guardian's Name

Place, Date of Birth

Citizenship

Daily Language

Religion

Full Address

Telephone Number

Handphone Number

Degree

Employment

Business Fields

Employment Position

Income

Office Telephone

Siblings

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