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PEMERINTAH KABUPATEN KERINCI

DINAS PENDIDIKAN
Komplek Perkantoran Bukit Tengah
SIULAK
Telp. (0748) 21341 Fax. (0748) 21059
Website :http://disdik.kerincikab.go.id e-mail : disdikkerinci@gmail.com Kode Pos 37162

FORMULIR PENDAFTARAN BEASISWA KERINCI CERDAS


TAHFIDZ AL-QUR’AN KABUPATEN KERINCI TAHUN 2020

A. Identitas Siswa/Mahasiswa
Nama : ..............................................................................................................
Alamat : .............................................................................................................
Usia : .............................................................................................................
Anak ke :..............................................................................................................
Jenis Kelamin :L/P
Asal Sekolah/Pontren : ............................................................................................................
Kelas : .............................................................................................................
Tel/Hp : ..............................................................................................................
Jumlah Hapalan ...................JUZ
B.Identitas Orang tua/Wali
Nama : .............................................................................................................
Alamat : .............................................................................................................
Pekerjaan Orang Tua
- Ayah :......................................................................
- Ibu :......................................................................
Pendidikan Terakhir
- Ayah :......................................................................
- Ibu :......................................................................
Tel/HP :.......................................................................

Persyaratan
1. Bukti masih aktif sebagai Pelajar dan Mahasiswa (Raport atau Transkrip Nilai)
2. Kartu Keluarga (Kabupaten Kerinci) dan KTP

Kerinci,................................................ 2020

Yang Menerima Yang Mendaftar,

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