FORMULIR PENDAFTARAN SANTRI BARU

TAMAN PENDIDIKAN AL-QUR’AN “ AL- FALAH ”

Jln. Ciliwung VIII ,Kel. Werungotok ,Kec. Nganjuk,Kab. Nganjuk

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A. IDENTITAS PENDAFTAR
1. Nama Lengkap : ..............................................................................................
2. Nama Panggilan : ...............................................................................................
3. NIK :……………………………………………………………………………………………
4. NIS : ..............................................................................................
5. Tempat/Tanggal Lahir :...............................................................................................
6. Jenis Kelamin : ...............................................................................................
7. Anak Ke : ...............................................................................................
8. Hobby : ...............................................................................................
9. Cita – Cita : ...............................................................................................
B. IDENTITAS ORANG TUA/WALI
IDENTITAS AYAH
1. Nama Ayah : ...............................................................................................
2. Tempat/Tanggal Lahir : ...............................................................................................
3. Pekerjaan : ...............................................................................................
4. Pendidikan Terakhir : ...............................................................................................
5. Alamat Rumah : ...............................................................................................
6. No. Telfon/HP : ...............................................................................................

IDENTITAS IBU
1. Nama Ibu : ...............................................................................................
2. Tempat/Tanggal Lahir : ...............................................................................................
3. Pekerjaan : ...............................................................................................
4. Pendidikan Terakhir : ...............................................................................................
5. Alamat Rumah : ...............................................................................................
6. No. Telfon/HP : ...............................................................................................
C. SYARAT-SYARAT PENDAFTARAN
1. Fotocopy akta 2 lembar
2. Fotocopy KK 2 lembar
3. Uang Pendaftaran Rp 10.000,00

Nganjuk, ..............................

` Orang Tua/Wali Santri

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