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MA LUGHATUL ISLAMIYAH

Jl. Raya Pantai Lombang Legung Timur


Telp : 085231291311 ⋅ Fax : - ⋅ Kode Pos : 69473
Email : info@malughatulislamiyah.sch.id ⋅ Website : malughatulislamiyah.sch.id

Formulir Penerimaan Peserta Didik Baru Tahun 2022

Registrasi Peserta Didik


Jenis Pendaftaran : Baru / Pindahan
Jalur Pendaftaran : Online
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 : .................................................................................................................

Alamat
Alamat Jalan : .................................................................................................................
Kelurahan / Desa : .................................................................................................................
Kecamatan : .................................................................................................................
Kabupaten : .................................................................................................................

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

.............................................., ............. .................................... 2022

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