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YAYASAN AL KAHFI BINA UKHUWAH

SEKOLAH MENENGAH PERTAMA ISLAM TERPADU


SMPIT AL KAHFI
NPSN : 69982634
Jl. Turusgede – Kumendung Rembang 59219 Sekretariat : 0852 9060 3159 E-mail: alkahfismp@gmail.com
FORMULIR PENDAFTARAN
CALON PESERTA DIDIK BARU SMPIT AL KAHFI
FOTO
TAHUN PELAJARAN 2020/2021
3X4

A. DATA DIRI PESERTA DIDIK


Nama Lengkap :...............................................................................................
Nama Panggilan :...............................................................................................

Jenis Kelamin :...............................................................................................


Agama :...............................................................................................
Tempat & Tanggal Lahir :...............................................................................................

Alamat :...............................................................................................
NISN :...............................................................................................
Hobi :...............................................................................................
Cita-cita :...............................................................................................
Anak Ke :...............................................................................................
Jumlah Saudara :...............................................................................................
Sekolah Asal :...............................................................................................
Riwayat Penyakit :...............................................................................................

B. DATA ORANG TUA


Nama Ayah Kandung :...............................................................................................
Nama Ibu Kandung :...............................................................................................
Alamat Orang Tua :...............................................................................................

Pekerjaan Ayah :...............................................................................................


Pekerjaan Ibu :...............................................................................................
No. HP/WA :...............................................................................................
Nama Orang Tua Wali : ..............................................................................................

Pekerjaan Wali : ..............................................................................................


Alamat Wali : ..............................................................................................
No. HP/WA :...............................................................................................
Rembang, ....................................... 2019
Orang Tua/Wali,
YAYASAN AL KAHFI BINA UKHUWAH
SEKOLAH MENENGAH PERTAMA ISLAM TERPADU
SMPIT AL KAHFI
NPSN : 69982634
Jl. Turusgede – Kumendung Rembang 59219 Sekretariat : 0852 9060 3159 E-mail: alkahfismp@gmail.com

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