YAYASAN LEMBAGA PENDIDIKAN ISLAM (YLPI)

SEKOLAH MENENGAH KEJURUAN

SMK MEKANIKA
Terakreditasi “B” No. 1442/BAN-SM/SK/2019
NPSN 20244687 NSS 322021708002
Jalan Buntet Pesantren Desa Mertapada Kulon Kecamatan Astanajapura Kabupaten Cirebon
Email : smkmekanika@gmail.com Telp. (0231) 636636, Kode Pos 45181 Web :smkmekanika.sch.id

FORMULIR PENDAFTARAN PESERTA DIDIK BARU

DATA SISWA No. Pendaftar :
Nama Lengkap : ______________________________________________________________
Tempat & Tanggal lahir : ______________________________________________________________
Jenis Kelamin : Laki-laki Perempuan
NISN : ______________________________________________________________
No. HP : ______________________________________________________________
Email Siswa/Siswi : ______________________________________________________________
Alamat Lengkap : ______________________________________________________________
______________________________________________________________
______________________________________________________________
Pilihan Jurusan 1 : TKRO TBSM MM PKM AKP
Pilihan Jurusan 2 : TKRO TBSM MM PKM AKP
Asal SMP/MTs : ______________________________________________________________
NPSN Sekolah Asal : ______________________________________________________________
Tahun Lulus : ______________________________________________________________
No. Ijazah : ______________________________________________________________
No. SKHUN : ______________________________________________________________
No Pesrta UN SMP/MTs : ______________________________________________________________
Keretangan : Pulang Pergi Mondok
Nama Pesantren : ______________________________________________________________
Nama Pengasuh Pondok : ______________________________________________________________
DATA ORANG TUA
A. Ayah
Nama Lemgkap : ______________________________________________________________
Tempat & Tanggal Lahir : ______________________________________________________________
Alamat Lengkap : ______________________________________________________________
______________________________________________________________
B. Ibu
Nama Lemgkap : ______________________________________________________________
Tempat & Tanggal Lahir : ______________________________________________________________
Alamat Lengkap : ______________________________________________________________
______________________________________________________________
No. HP/WA : ______________________________________________________________
Pendidikan Terakhir : ______________________________________________________________
Pekerjaan : ______________________________________________________________

Buntet Pesantren, 20
Calon Siswa/Siswi

Pas Photo
3x4
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