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SMA NEGERI 1 MEUREUDU

Jln. Iskandar Muda No.7 Desa Rhieng Blang Meureudu , Kabupaten Pidie Jaya , Aceh
Telp : 0653-51001 ⋅ Fax : - ⋅ Kode Pos : 24186 NPSN: 10100575
Email : sman1meureudu74@gmail.com ⋅ Website : sman1mrd.sch.id

Formulir Penerimaan Peserta Didik Baru

Registrasi Peserta Didik

Jenis Pendaftaran : Baru / Pindahan


Nomor Pendaftaran : ....................................................................................... ( Diisi Panitia )
Tanggal Pendaftaran : ....................................................................................... ( Diisi Panitia )
Nama Sekolah Asal : .................................................................................................................
Alamat Sekolah Asal : .................................................................................................................

Biodata Peserta Didik


Nama Lengkap : .................................................................................................................
Jenis Kelamin : Laki-laki / Perempuan
NISN : .................................................................................................................
NIK : .................................................................................................................
Tempat Lahir : .................................................................................................................
Tanggal Lahir : .................................................................................................................
Yatim/Piatu/Yatimpiatu : .................................................................................................................
Agama : .................................................................................................................

Biodata Orang Tua


Nama Ayah Kandung : .................................................................................................................
Pendidikan Terakhir Ayah : .................................................................................................................
PekerjaanAyah : .................................................................................................................
Nama Ibu Kandung : .................................................................................................................
Pendidikan Terakhir Ibu : .................................................................................................................
Pekerjaan Ibu : .................................................................................................................
catatan : isikan “sudah meninggal” dipekerjaan Ayah/Ibu jika sudah tiada.
Alamat
Alamat Jalan : .................................................................................................................
Kelurahan / Desa : .................................................................................................................
Kecamatan : .................................................................................................................
Kabupaten : .................................................................................................................
Email : .................................................................................................................
Nomor HP / WA : .................................................................................................................

Saya yang bertandatangan dibawah ini menyatakan bahwa data yang tertera diatas adalah yang sebenarnya.

Meureudu, …………………… 20…..


Peserta Didik Baru

(............................................................)

====== PPDB SMA Negeri 1 Meureudu ======


PERSRATAN BERKAS LAMPIRAN

SISWA BARU

1. PRINT OUT DATA NISN YANG DI DOWNLOAD DI WEB https://nisn.data.kemdikbud.go.id/

( Jika tidak bisa mencari sendiri silahkan diminta di sekolah asal )

2. KK (KARTU KELUARGA)

3. AKTA KELAHIRAN

4. KARTU SOSIAL ( PIP / PKH / KPS ) JIKA ADA

5. PAS PHOTO 4 X 6 (…… LEMBAR)

SISWA PINDAHAN

1. PRINT OUT DATA ONLINE MUTASI SISWA DARI DAPODIK ATAU EMIS PENDIS

2. KK (KARTU KELUARGA)

3. AKTA KELAHIRAN

4. KARTU SOSIAL ( PIP / PKH / KPS ) JIKA ADA