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YAYASAN PONDOK PESANTREN FALAHURRAHMAN

SDIT FALAHURRAHMAN
Dusun Cibadak 15/04 Desa Jatinagara Kec. Jatinagara Kab. Ciamis 46273

FORMULIR PENDAFTARAN PESERTA DIDIK BARU


SDIT FALAHURRAHMAN
TAHUN PELAJARAN 2023-2024

A. Identitas Anak
Nama Lengkap : ..........................................................................................................................
Tempat, Tanggal Lahir : ..........................................................................................................................
Anak ke : ..........................................................................................................................
Jumlah Saudara : ..........................................................................................................................
Alamat Siswa : Dusun : ......................................................... RT …….. RW ……...
Desa : ..............................................................................................
Kecamatan : ..............................................................................................
Kabupaten : ..............................................................................................

B. Identitas Orang tua


Nama Lengkap Ayah : ...............................................................................................................
Nama Lengkap Ibu : ...............................................................................................................
Pendidikan Terakhir Ayah : ...............................................................................................................
Pendidikan Terakhir Ibu : ...............................................................................................................
Pekerjaan Ayah : ...............................................................................................................
Pekerjaan Ibu : ...............................................................................................................
No. Tlp/HP : ...............................................................................................................

Lampirkan :
1. Foto Copy Kartu Keluarga (KK) Orang Tua/Wali yang Mendaftarkan
2. Foto Copy KTP Ayah dan Ibu
3. Foto Copy Akta Lahir (Jika ada)
4. Foto Copy Ijazah PAUD/RA

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