FORMULIR PENDAFTARAN SNBP 2024

NAMA :…………………………………………………………………………………………………….
NO.KK :…………………………………………………………………………………………………….

NIK :…………………………………………………………………………………………………….

NISN :……………………………………………………………………………………………………

JENIS KELAMIN :…………………………………………………………………………………………………….

AGAMA :……………………………………………………………………………………………………

TEMPAT LAHIR :…………………………………………………………………………………………………….

TANGGAL LAHIR :…………………………………………………………………………………………………….

ALAMAT :…………………………………………………………………………………………………….

EMAIL :…………………………………………………………………………………………………….

KODE POS :……………………………………………………………………………………………………

NO HP :…………………………………………………………………………………………………….

NAMA AYAH/STATUS :…………………………………………………………………………………………………….

NAMA IBU/STATUS :…………………………………………………………………………………………………..

HUB.DENGAN AYAH IBU :…………………………………………………………………………………………………….

PENDIDIKAN AYAH :……………………………………………………………………………………………………

PEKERJAAN AYAH :……………………………………………………………………………………………………

PENDIDIKAN IBU :……………………………………………………………………………………………………

PEKERJAAN IBU :…………………………………………………………………………………………………….

JUMLAH TANGGUNGAN :…………………………………………………………………………………………………….

NO HP ORTU :……………………………………………………………………………………………………

BIAYA UP :……………………………………………………………………………………………………

BIAYA SPP :…………………………………………………………………………………………………..

TOTAL PENDAPATAN ORTU :…………………………………………………………………………………………………..

PILIHAN PTN
SNBP :1...............................................................................................................................
2...............................................................................................................................
SPAN PTKIN :1................................................................ 3........................................................
2................................................................ 4.........................................................
SNBT :1...............................................................................................................................
2...............................................................................................................................
POLITEKNIK :1..............................................................................................................................
2..............................................................................................................................