FORMULIR PPDB 2020-2021

FORMULIR PENDAFTARAN SISWA BARU

Nomor pendaftaran :...................................................

A.      IDENTITAS SISWA: 1.       Nama Lengkap (sesuai Ijazah) 2.       Jenis Kelamin 3.       Tempat & Tanggal lahir 4.       Agama 5.       Alamat sekarang 6.       Sekolah Asal: a.       Nama sekolah b.      Alamat Sekolah 7.       Nomor STTB/Tahun lulus 8.       Nomor SKHUN 9.       Jumlah Nilai STTB/rata-rata	: : : : : : : : : :	......................................................................................... ......................................................................................... ......................................................................................... ......................................................................................... ......................................................................................... ......................................................................................... ......................................................................................... ......................................................................................... ......................................................................................... .........................................................................................
B.      IDENTITAS ORANG TUA (AYAH) 1.       Nama Ayah 2.       Tempat & Tanggal Lahir 3.       Agama 4.       Pekerjaan 5.       Alamat sekarang	: : : : :	......................................................................................... ......................................................................................... ......................................................................................... ......................................................................................... .........................................................................................
C.      IDENTITAS ORANG TUA (IBU) 1.        Nama ibu 2.       Tempat & Tanggal Lahir 3.       Agama 4.       Pekerjaan 5.       Alamat sekarang	: : : : :	......................................................................................... ......................................................................................... ......................................................................................... ......................................................................................... .........................................................................................

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Cisurupan, ............................2019

	Panitia PPDB .......................................	Calon Siswa ..........................................
	Mengetahui Kepala Sekolah Aep Saepul Rohman, SE