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  • Formulir Pendaftaran PPDB 22-23

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    10 views1 page

    Formulir Pendaftaran PPDB 22-23

    Uploaded by

    noris sobarna

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 1

    - - = FORMULIR PENDAFTARAN = - -

    Identitas Siswa
    Nama Siswa : __________________________________________________________________
    N I K Siswa : __________________________________________________________________
    Tempat/Tgl Lahir : __________________________________________________________________
    Alamat Siswa : __________________No._______ RT____ RW____ Kel___________________
    Kec______________________ Kota_______________Kode Pos_____________
    Anak Ke : _____ dari _____ bersaudara
    Asal SMP : __________________________________________________________________
    NISN : __________________________________________________________________
    Kartu Subsidi* : KIP / KIS / ___________ (*Coret yang tidak perlu)
    No Hp Siswa : __________________________________________________________________

    Identitas Orang Tua


    Nama Ayah : __________________________________________________________________
    No. KTP / N I K : __________________________________________________________________
    Pekerjaan Ayah : __________________________________________________________________
    Penghasilan Ayah* : Tidak Berpenghasilan / Kurang dari Rp.500.000,- / Rp. 500,000 - Rp. 999,999 /
    Rp. 1,000,000 - Rp. 1,999,999 / Rp. 2,000,000 - Rp. 4,999,999 (*Coret yang tidak perlu)
    Nama Ibu : __________________________________________________________________
    No. KTP / N I K : __________________________________________________________________
    Pekerjaan Ibu : __________________________________________________________________
    Penghasilan Ibu* : Tidak Berpenghasilan / Kurang dari Rp.500.000,- / Rp. 500,000 - Rp. 999,999 /
    Rp. 1,000,000 - Rp. 1,999,999 / Rp. 2,000,000 - Rp. 4,999,999 (*Coret yang tidak perlu)
    Alamat Orang Tua : __________________No._______ RT____ RW____ Kel___________________
    Kec______________________ Kota_______________Kode Pos_____________
    No. Hp Orang Tua : __________________________________________________________________

    Identitas Wali Siswa (Jika Ada)


    Nama Wali Siswa : __________________________________________________________________
    No. KTP / N I K : __________________________________________________________________
    Pekerjaan Wali Siswa : __________________________________________________________________
    Alamat Wali Siswa : __________________No._______ RT____ RW____ Kel___________________
    Kec______________________ Kota_______________Kode Pos_____________
    No. Hp Wali Siswa : __________________________________________________________________

    PERSYARATAN PENDAFTARAN
    1. Formulir Pendaftaran
    2. Foto Copy Ijazah & SKHUN : 3 Lembar
    3. Foto Copy Akte Kelahiran : 3 Lembar
    4. Foto Copy Kartu Keluarga : 3 Lembar
    5. Foto Copy KTP Orang Tua/Wali : 3 Lembar
    6. Pas Photo 3 x 4 : 6 Lembar
    7. SKTM/Kartu PIP/KKS (bagi yang memiliki)
    8. Foto Copy Raport & Surat Mutasi dari Pihak Sekolah
    dan DAPODIK (bagi yang Siswa Mutasi)

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