1. IDENTITAS
a. NAMA : .........................................................................................
b. STATUS SEKOLAH : .........................................................................................
c. STATUS AKREDITASI : ............................TAHUN ................................................
d. ALAMAT SEKOLAH : .........................................................................................
KECAMATAN : .........................................................................................
KABUPATEN/KOTA : .........................................................................................
e. HARI/TANGGAL : .........................................................................................
f. NAMA KEPALA SEKOLAH : .........................................................................................
g. NIP/NUPTK : .........................................................................................
2. DATA SISWA
a. Jumlah rombel peserta didik baru : ................ rombel,
b. Jumlah siswa peserta didik baru
1. Jumlah siswa melalui jalur akademik : .......................... siswa
2. Jalur Prestasi : .......................... siswa
3. Jalur Afirmasi : .......................... siswa
4. Jalur nota kesepahaman (MOU) : .......................... siswa
5. Siswa disabilitas : .......................... siswa
c. Jumlah siswa tidak naik kelas : .......................... siswa
Jumlah Total siwa kelas X : .......................... siswa
3. ADMINISTRASI
a. Kepanitiaan
1. Memiliki SK kepanitiaan ada tidak ada
2. Jumlah panitia : ....................... orang, tim verifikasi : ..................... orang
tim seleksi : ....................... orang, tim visitasi : ..................... orang
b. Memiliki jadwal tes praktek ada tidak ada
c. Program kerja PPDB 2017 ada tidak ada
d. Landasan Hukum
1. Permendikbud No. 17 tahun 2017 ada tidak ada
2. Pergub Jabar No.16 tahun 2017 ada tidak ada
3. Juknis Prov Jabar PPDB 2017 ada tidak ada
4. POS / Juknis PPDB Sekolah ada tidak ada
e. Sosialisasi terhadap stake-holder dilakukan tidak dilakukan
f. Terdapat Informasi PPDB di sekolah ada tidak ada
3. SARANA PRASARANA
a. Ruang khusus panra ada tidak ada
b. Fasilitas pendaftaran online ada tidak ada
c. Fasilitas tes praktek ada tidak ada
d. Tempat penyimpanan dokumen ada tidak ada
KESIMPULAN
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SARAN
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