FORMULIR PENDAFTARAN SISWA BARU

KURSUS KOMPUTER

I. DATA SISWA
1. NIK :
2. Nama Lengkap :........................................................................................
3. Nama Panggilan :........................................................................................
4. Tempat / Tanggal Lahir :........................................................................................
5. Agama :........................................................................................
6. Pendidikan Terakhir :........................................................................................
7. Alamat :........................................................................................
8. No HP/WA :........................................................................................
II. DATA ORANG TUA
1. Nama Ayah :........................................................................................
2. Pekerjaan :........................................................................................
3. Nama Ibu :........................................................................................
4. Pekerjaan :........................................................................................
5. Alamat :........................................................................................
III. SYARAT-SYARAT PENDAFTARAN
1. Copy Kartu KK : 2 Lembar
2. Copy KTP : 2 Lembar
3. Copy Ijazah Terakhir : 2 Lembar
4. Phas Photo 3X4 : 8 Lembar
5. ................................. :.......................
6.
IV. PROGRAM PENDAFTARAN
Reguler PKK PKW

Penerima / Petugas, Cianjur, .................................... 20

Pendaftar,

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