Format Usulan Siswa Penerima Bantuan Siswa Miskin (BSM) / Program Indonesia Pintar

(PIP) Tahun 2015

<table border='0'>
<tr>
<td>Nama Sekolah</td><td>:</td><td>SMKS TARUNA TARIK</td>
</tr>
<tr>
<td>Propinsi</td><td>:</td><td>Prop. Jawa Timur</td>
</tr>
<tr>
<td>Kabupaten</td><td>:</td><td>Kab. Sidoarjo</td>
</tr>
</table>

<table border='1'>
<tr>
<th>No.</th>
<th>NPSN</th>
<th>Nama Sekolah</th>
<th>Nama Siswa</th>
<th>NISN</th>
<th>Kelas</th>
<th>Jenis Kelamin</th>
<th>Tanggal Lahir</th>
<th>Nama Ibu Kandung</th>
<th>Nama Ayah</th>
<th>Nama Wali</th>
<th>Kriteria Penerima</th>
</tr>
<tr>
<td align='center'>1</td>
<td align='center'>2</td>
<td align='center'>3</td>
<td align='center'>4</td>
<td align='center'>5</td>
<td align='center'>6</td>
<td align='center'>7</td>
<td align='center'>8</td>
<td align='center'>9</td>
<td align='center'>10</td>
<td align='center'>11</td>
<td align='center'>12</td>
</tr><tr>
<td>1</td>
<td>20501719</td>
<td>SMKS TARUNA TARIK</td>
<td>PUTRI INDAH SARI</td>
<td>9988288143</td>
<td>12</td>
<td>P</td>
<td>1998-09-26</td>
<td>JUWANIK</td>
<td>WARAS</td>
<td></td>
<td>Tidak Mampu</td>
</tr><tr>
<td>2</td>
<td>20501719</td>
<td>SMKS TARUNA TARIK</td>
<td>LAILATUL IZTIMA</td>
<td>9984103698</td>
<td>12</td>
<td>P</td>
<td>1998-06-19</td>
<td>KHAMNAH</td>
<td>MOCH.KHOLIL</td>
<td></td>
<td>Tidak Mampu</td>
</tr><tr>
<td>3</td>
<td>20501719</td>
<td>SMKS TARUNA TARIK</td>
<td>Fera Iqbal Sari</td>
<td>9995655490</td>
<td>11</td>
<td>P</td>
<td>1999-08-11</td>
<td>WIWIT RAHAYU</td>
<td>SLAMET WIDODO</td>
<td></td>
<td>Tidak Mampu</td>
</tr><tr>
<td>4</td>
<td>20501719</td>
<td>SMKS TARUNA TARIK</td>
<td>ALIMI NUR AJIJAH</td>
<td>9978086528</td>
<td>12</td>
<td>P</td>
<td>1997-03-13</td>
<td>SUNARTI</td>
<td>SIAMAN</td>
<td></td>
<td>Tidak Mampu</td>
</tr><tr>
<td>5</td>
<td>20501719</td>
<td>SMKS TARUNA TARIK</td>
<td>SITI MASFUFAH</td>
<td>9988169485</td>
<td>11</td>
<td>P</td>
<td>1998-06-26</td>
<td>SITI FATIMAH</td>
<td>HERIANTO</td>
<td></td>
<td>Tidak Mampu</td>
</tr><tr>
<td>6</td>
<td>20501719</td>
<td>SMKS TARUNA TARIK</td>
<td>SITI INDRIANI</td>
<td>9978521270</td>
<td>12</td>
<td>P</td>
<td>1997-11-01</td>
<td>SITI RUMIANI</td>
<td>M.GOFUR</td>
<td></td>
<td>Tidak Mampu</td>
</tr><tr>
<td>7</td>
<td>20501719</td>
<td>SMKS TARUNA TARIK</td>
<td>ayu maulidia</td>
<td>9996540021</td>
<td>11</td>
<td>P</td>
<td>1999-07-07</td>
<td>JUWARIYAH</td>
<td>SUGIONO</td>
<td></td>
<td>Tidak Mampu</td>
</tr><tr>
<td>8</td>
<td>20501719</td>
<td>SMKS TARUNA TARIK</td>
<td>YULIANA</td>
<td>9987264404</td>
<td>12</td>
<td>P</td>
<td>1998-02-16</td>
<td>SUPARTI</td>
<td>WARSIMIN</td>
<td></td>
<td>Tidak Mampu</td>
</tr><tr>
<td>9</td>
<td>20501719</td>
<td>SMKS TARUNA TARIK</td>
<td>ELOK SENJA PUSPITA RANI</td>
<td>9981882158</td>
<td>12</td>
<td>P</td>
<td>1998-04-14</td>
<td>SRIANI</td>
<td>IMAM</td>
<td></td>
<td>Tidak Mampu</td>
</tr><tr>
<td>10</td>
<td>20501719</td>
<td>SMKS TARUNA TARIK</td>
<td>PUTRI DWI LESTARI</td>
<td>9985457678</td>
<td>12</td>
<td>P</td>
<td>1998-06-11</td>
<td>JUANI</td>
<td>NUR HASAN</td>
<td></td>
<td>Tidak Mampu</td>
</tr><tr>
<td>11</td>
<td>20501719</td>
<td>SMKS TARUNA TARIK</td>
<td>PINGKY MEI ADELLINE</td>
<td>9985455838</td>
<td>12</td>
<td>P</td>
<td>1998-05-22</td>
<td>MINUK</td>
<td>KHOIRIL</td>
<td></td>
<td>Tidak Mampu</td>
</tr><tr>
<td>12</td>
<td>20501719</td>
<td>SMKS TARUNA TARIK</td>
<td>HELFI SURYA NINGSIH</td>
<td>9966905588</td>
<td>12</td>
<td>P</td>
<td>1996-11-18</td>
<td>PAINI</td>
<td>SISWOYO</td>
<td></td>
<td>Tidak Mampu</td>
</tr><tr>
<td>13</td>
<td>20501719</td>
<td>SMKS TARUNA TARIK</td>
<td>TRI YUNI MILIN DASARI</td>
<td>9981882164</td>
<td>12</td>
<td>P</td>
<td>1998-06-10</td>
<td>RUSINAH</td>
<td>NGADI</td>
<td></td>
<td>Tidak Mampu</td>
</tr><tr>
<td>14</td>
<td>20501719</td>
<td>SMKS TARUNA TARIK</td>
<td>UPI MEGA ANGGRAINI</td>
<td>9989025170</td>
<td>12</td>
<td>P</td>
<td>1998-05-10</td>
<td>SAMIATI</td>
<td>SUPARDI</td>
<td></td>
<td>Tidak Mampu</td>
</tr><tr>
<td>15</td>
<td>20501719</td>
<td>SMKS TARUNA TARIK</td>
<td>NUR FILAILI</td>
<td>9985457528</td>
<td>12</td>
<td>P</td>
<td>1998-04-29</td>
<td>RANTI YANI YANTI</td>
<td>MAD JUDI</td>
<td></td>
<td>Tidak Mampu</td>
</tr><tr>
<td>16</td>
<td>20501719</td>
<td>SMKS TARUNA TARIK</td>
<td>RATNA NUR LAILI</td>
<td>9963066058</td>
<td>12</td>
<td>P</td>
<td>1996-11-11</td>
<td>uslikah</td>
<td>NURUDIN</td>
<td></td>
<td>Tidak Mampu</td>
</tr><tr>
<td>17</td>
<td>20501719</td>
<td>SMKS TARUNA TARIK</td>
<td>SITI JUMAROH</td>
<td>9976627711</td>
<td>11</td>
<td>P</td>
<td>1997-11-10</td>
<td>KASIH</td>
<td>JUMALI</td>
<td></td>
<td>Tidak Mampu</td>
</tr><tr>
<td>18</td>
<td>20501719</td>
<td>SMKS TARUNA TARIK</td>
<td>MUSTAGFIROH</td>
<td>9974402124</td>
<td>12</td>
<td>P</td>
<td>1997-05-08</td>
<td>SITI NUR CHOIRIYAH</td>
<td>ASMADI</td>
<td></td>
<td>Tidak Mampu</td>
</tr><tr>
<td>19</td>
<td>20501719</td>
<td>SMKS TARUNA TARIK</td>
<td>ENDANG SUSILOWATI</td>
<td>9987774908</td>
<td>12</td>
<td>P</td>
<td>1998-03-07</td>
<td>SUPIATI</td>
<td>MULYADI</td>
<td></td>
<td>Tidak Mampu</td>
</tr><tr>
<td>20</td>
<td>20501719</td>
<td>SMKS TARUNA TARIK</td>
<td>ANA RAHMAWATI</td>
<td>9979764644</td>
<td>12</td>
<td>P</td>
<td>1997-02-02</td>
<td>HIDAYATUL ILMIAH</td>
<td>NUR KHOLIS</td>
<td></td>
<td>Tidak Mampu</td>
</tr><tr>
<td>21</td>
<td>20501719</td>
<td>SMKS TARUNA TARIK</td>
<td>RISKA DWI LESTARI</td>
<td>9979027222</td>
<td>12</td>
<td>P</td>
<td>1997-06-03</td>
<td>LIANIATI</td>
<td>SUWARNO</td>
<td></td>
<td>Tidak Mampu</td>
</tr><tr>
<td>22</td>
<td>20501719</td>
<td>SMKS TARUNA TARIK</td>
<td>KHOIRUN NISAK</td>
<td>9974267457</td>
<td>12</td>
<td>P</td>
<td>1997-10-05</td>
<td>MAS'UDAH</td>
<td>SUWADJI</td>
<td></td>
<td>Tidak Mampu</td>
</tr><tr>
<td>23</td>
<td>20501719</td>
<td>SMKS TARUNA TARIK</td>
<td>MAULIDA ROSALIA</td>
<td>9977221136</td>
<td>12</td>
<td>P</td>
<td>1997-07-06</td>
<td>KHOIRUL ISWAH</td>
<td>SHOLEH FARKHAN</td>
<td></td>
<td>Tidak Mampu</td>
</tr><tr>
<td>24</td>
<td>20501719</td>
<td>SMKS TARUNA TARIK</td>
<td>NOVITA SURYA WINDI</td>
<td>9975015504</td>
<td>12</td>
<td>P</td>
<td>1997-11-20</td>
<td>WINARSIH</td>
 <td>PONIDI</td>
<td></td>
<td>Tidak Mampu</td>
</tr>
</table>