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FORMULIR PENERIMAAN PESERTA DIDIK BARU

SMA NEGERI 9 KUNINGAN


TAHUN 2016
Alamat : Jalan Raya Kadugede No. 11 Desa/Kec. Kadugede - Kuningan Jawa Barat 45561 Telp :
123456789
Email : cmssekolahku@gmail.com - Website : sekolahku.web.id

Nomor Pendaftaran : *............................................................................................


Tanggal Pendaftaran : *............................................................................................
Jalur Pendaftaran : .............................................................................................
Sekolah Asal : .............................................................................................
NISN : .............................................................................................
Nama Calon Peserta Didik : .............................................................................................
Tempat, Tanggal Lahir : .............................................................................................
Jenis Kelamin : .............................................................................................
Agama : .............................................................................................
Status dalam Keluarga : .............................................................................................
Anak ke : .............................................................................................
Alamat : .............................................................................................
Nomor Telepon : .............................................................................................
Email : .............................................................................................
Nama Ayah : .............................................................................................
Nama Ibu : .............................................................................................
Alamat Orang Tua : .............................................................................................
Nomor Telepon Orang Tua : .............................................................................................
Pekerjaan Ayah : .............................................................................................
Pekerjaan Ibu : .............................................................................................
Nama Wali : .............................................................................................
Alamat Wali : .............................................................................................
Nomor Telepon Wali : .............................................................................................
Pekerjaan Wali : .............................................................................................

Kuningan,......................................... 2016
Calon Peserta Didik, Panitia PPDB,

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Ket : Isian dengan tanda (*) diisi oleh panitia PPDB

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