FORMULIR PENDAFTARAN SISWA BARU

A. KETERANGAN CALON PESERTA DIDIK

1. Nama Lengkap : .................................................................................................................................
2. Nama Penggilan : .................................................................................................................................
3. Jenis Kelamin : (Laki-laki / Perempuan)*
4. Tempat, Tgl Lahir : .................................................................................................................................
5. Anak Ke : .............................. (............................)
6. Alamat Tempat Tinggal :Jl ................................................... RT ....... RW ........ Ds .....................................
Kec ................................................. Kab ................................................................
7. No. Telp/HP : .................................................................................................................................
B. KETERANGAN BAKAT DAN MINAT CALON PESERTA DIDIK
1. Hobi : .....................................................................................................................
2. Bidang studi yang paling digemari : .....................................................................................................................
3. Olah raga yang paling digemari : .....................................................................................................................
4. Cita-cita : .....................................................................................................................
C. KETERANGAN ORANG TUA KANDUNG
1. Nama Lengkap
a. Ayah : .............................................................................................................................................
b. Ibu : .............................................................................................................................................
2. Tempat, Tgl Lahir
a. Ayah : .............................................................................................................................................
b. Ibu : .............................................................................................................................................
3. Pekerjaan
a. Ayah : .............................................................................................................................................
b. Ibu : .............................................................................................................................................
4. Alamat : Jl ................................................... RT .............. RW................ Ds....................................
Kec............................................... Kab ................................................................................
5. Penghasilan rata-rata perbulan
a. Ayah : .............................................................................................................................................
b. Ibu : .............................................................................................................................................
D. KETERANGAN WALI
1. Nama Lengkap : .............................................................................................................................................
2. Jenis Kelamin : .............................................................................................................................................
3. Pekerjaan : .............................................................................................................................................
4. Alamat : Jl.................................................RT .................. RW .............. Ds.....................................
Kec ............................................ Kab ..................................................................................
5. Penghasilan Perbulan: .............................................................................................................................................
Mengetahui Bogor,.................................20....
Orang Tua / Wali Murid Calon Peserta Didik

3X4
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