DATABASE PPDB TAHUN 2023/2024

1. Nama Peserta Didik (Lengkap) : ...............................................................................

2. Nomor Induk Siswa Nasional/ NIS
3. Tempat dan Tanggal Lahir
4. Jenis Kelamin
5. Agama
6. Status dalam Keluarga
7. Anakke
8. Alamat Peserta Didik
: ...............................................................................
: ...............................................................................
: ...............................................................................
: ...............................................................................
: ...............................................................................
: ...............................................................................
: ..................................................................................................

9. Nomor Telepon Rumah : ...............................................................................

10. Sekolah Asal (SMP/MTs) : ...............................................................................
11. Diterima di sekolah ini
a. Di kelas : ...............................................................................
b. Pada tanggal :
12. Ijazah SMP/MTs
a. Tahun :
b. Nomor : ............................................................................
13. Orang Tua
a. Nama Ayah : .............................................................................
b. Nama Ibu : .............................................................................
c. Alamat : ...............................................................................................
d. Nomor Telepon / HP : .............................................................................
14. Pekerjaan Orang Tua
a. Ayah : ............................................................................
b. Ibu : .............................................................................
c. Nama Wali Peserta Didik : .............................................................................
d. NamaWali : ...............................................................................
e. Nomor Telepon / HP : ..............................................................................
f. Alamat : .............................................................................
g. Pekerjaan : .............................................................................