YAYASAN KAWIT AN NUR SLAWI

PONDOK PESANTREN AN NUR

Alamat : Jl. RA. Kartini RT 05/09 Desa Kalisapu Kec. Slawi Kab. Tegal

FORMULIR PENDAFTARAN

A. Calon Santri
Nama : ...........................................................................
Tempat Tanggal Lahir : ...........................................................................
Foto
Jenis Kelamin : ........................................................................... 3x4
Agama : ...........................................................................
Status dalam Keluarga : ...........................................................................
Anak Ke : ...........................................................................
Jumlah Saudara : ...........................................................................
Alamat Rumah : ...........................................................................
Nomor Telepon : ...........................................................................
Sekolah Asal : ...........................................................................
Nomor NISN : ...........................................................................
B. Orang Tua
a) Ayah
Nama : ...........................................................................
Alamat : ...........................................................................
Pekerjaan : ...........................................................................
Nomor Telepon : ...........................................................................
b) Ibu
Nama : ...........................................................................
Alamat : ...........................................................................
Pekerjaan : ...........................................................................
Nomor Telepon : ...........................................................................
C. Wali Santri
Nama : ...........................................................................
Alamat : ...........................................................................
Pekerjaan : ...........................................................................
Nomor Telepon : ...........................................................................

Slawi, ........................................

Calon Santri Panitia Penerimaan Santri Baru

............................................... ...................................................
 YAYASAN KAWIT AN NUR SLAWI
TPQ AN NUR
TAHUN PELAJARAN 2017/2018
Alamat : Jl. Wader Gg. Mbah Albi RT 03/05 Desa Kalisapu Kec. Slawi Kab. Tegal

FORMULIR PENDAFTARAN SANTRI BARU

PUTRA – PUTRI

1. NIK Santri : ...............................................................................................................

2. NIS TPQ An Nur : ...............................................................................................................
3. Nama Lengkap : ...............................................................................................................
4. Nama Panggilan : ...............................................................................................................
5. Tempat Tanggal Lahir : ...............................................................................................................
6. Alamat : ...............................................................................................................
: ............................................., Telp : .....................................................
7. Jenis Kelamin : ...............................................................................................................
8. Pendidikan : ...............................................................................................................
9. Nama Orang Tua / Wali
Ayah : ...............................................................................................................
Ibu : ...............................................................................................................
Wali : ...............................................................................................................
Alamat : ..................... Desa....................... Kec....................... Kab...................
No. Telepon : ...............................................................................................................
10. Pekerjaan
Ayah : ...............................................................................................................
Ibu : ...............................................................................................................
Wali : ...............................................................................................................
Penghasilan Rata-Rata : Rp..........................................................................................................
11. Sekolah Formal : YA / TIDAK
12. Kelas : ...............................................................................................................

3x4

Slawi, ........................................
Mengetahui
Orang Tua / Wali Calon Santri

............................................... ................................................

*) Wajib diisi semua data dengan lengkap dan data valid (benar)