| No. | No. Induk | Nama Siswa | Tempat, Tanggal Lahir | Nama Orang Tua / Wali | Melanjutkan Ke- |
| 01. | ....... | ....... | Jember, ......... 199 | .......... | .......... |
| 02. | ....... | ....... | Jember, ......... 199 | .......... | .......... |
| 03. | ....... | ....... | Jember, ......... 199 | .......... | .......... |
| 04. | ....... | ....... | Jember, ......... 199 | .......... | .......... |
| 05. | ....... | ....... | Jember, ......... 199 | .......... | .......... |
| 06. | ....... | ....... | Jember, ......... 199 | .......... | .......... |
| 07. | ....... | ....... | Jember, ......... 199 | .......... | .......... |
| 08. | ....... | ....... | Jember, ......... 199 | .......... | .......... |
| 09. | ....... | ....... | Jember, ......... 199 | .......... | .......... |
| 10. | ....... | ....... | Jember, ......... 199 | .......... | .......... |
| 11. | ....... | ....... | Jember, ......... 199 | .......... | .......... |
| 12. | ....... | ....... | Jember, ......... 199 | .......... | .......... |
| 13. | ....... | ....... | Jember, ......... 199 | .......... | .......... |
Halaman 7