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PENERIMAAN PESERTA DIDIK BARU (PPDB)

TAHUN AJARAN 2022-2023


PENDIDIDKAN ANAK USIA DINI (PAUD) TUNAS MULIA

IDENTITAS ANAK

1. Nama Lengkap : ........................................................................................


2. Nama Panggilan : ........................................................................................
3. NIK : ........................................................................................
4. Tempat dan Tanggal Lahir : ........................................................................................
5. Agama : ........................................................................................
6. Suku/Kewarganegaraan : ........................................................................................
7. Alamat Lengkap : ........................................................................................
........................................................................................
8. Tinggal Bersama : ........................................................................................
9. Anak ke : ........................................................................................
10. Jumlah Saudara : ........................................................................................
11. Usia : ........................................................................................
12. TB/BB : ........................................................................................
13. Jarak Tempuh ke Sekolah : ........................................................................................

ORANG TUA / WALI

1. Nama Ayah : ........................................................................................


NIK : ........................................................................................
Tahun Lahir : ........................................................................................
Pendidikan : ........................................................................................
Pekerjaan : ........................................................................................
2. Nama Ibu : ........................................................................................
NIK : ........................................................................................
Tahun Lahir : ........................................................................................
Pendidikan : ........................................................................................
Pekerjaan : ........................................................................................
3. Nama Wali : ........................................................................................
NIK : ........................................................................................
Tahun Lahir : ........................................................................................
Pendidikan : ........................................................................................
Pekerjaan : ........................................................................................

REGISTER

1. Jenis Pendaftaran : A. Siswa Baru B. Pindahan C. Sekolah Lagi


2. Masuk Rombel : A. PG (2-4 thn) B. Kel.A (4-5 thn) C. Kel.B (5-6 thn)

Orang Tua / Wali Siswa

……………………………
Melampirkan:
Foto Kopi Akte Kelahiran
Foto Kopi KTP Orang Tua/Wali
Foto Kopi Kartu Keluarga

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