YAYASAN PENDIDIKAN TRI BHAKTI

SMP SWASTA TRI BHAKTI PIR TRANS SOSA IV KEC. HUTARAJA TINGGI
KABUPATEN PADANG LAWAS
Alamat : Jl.Poros PIR Trans Sosa IV Kec. Hutaraja Tinggi kode pos (22764)

FORMULIR PENDAFTARAN PESERTA DIDIK BARU (PPDB) T.P 2021 / 2022

I. IDENTITAS SISWA

a. Nama Siswa :.................................................................

b. Tempat Tgl Lahir :.................................................................
c. Jenis Kelamin : Laki-laki/Perempuan
d. NISN :.................................................................
e. Agama :.................................................................
f. NIK :.................................................................

II. IDENTITAS ORANG TUA /WALI

a. Nama Ayah :.................................................................

b. Temp.Tagl lahir :................................................................
c. Pendidikan terakhir : SD / SMP / SMA / S.1
d. Pekerjaan :................................................................

a. Nama Ibu : ...............................................................

b. Temp.Tgl Lahir :................................................................
c. Pendidikan Terakhir :................................................................
d. Pekerjaan :................................................................

III.. ASAL SEKOLAH

a. Nama Sekolah :................................................................

b. NSS/NPSN :................................................................
c. Alamat Sekolah :................................................................

PIR Trans Sosa IV,.............Juni 2021

Mengetahui

Orang Tua / Wali Nama Calon Siswa

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