PENERIMAAN PESERTA DIDIK BARU ( PPDB )

TAHUN AJARAN 2023 – 2024

PENDIDIKAN ANAK USIA DINI ( PAUD )
IDENTITAS

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

2. Jenis Kelamin : .............................................................................................................................................
3. NIK : .......................................................... No. Kartu Keluarga …………..................................
4. Tempat/Tgl Lahir : ........................................................... No. Akte Kelahiran …………..................................
5. Agama : .............................................................................................................................................
6. Kewarganegaraan : .............................................................................................................................................
7. Alamat Lengkap : .............................................................................................................................................
: .............................................................................................................................................
8. Tinggal Bersama : .............................................................................................................................................
9. Anak Ke : .............................................................................................................................................
10. Usia : .............................................................................................................................................
11. No. HP : .............................................................................................................................................
ORANG TUA

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

NIK : .............................................................................................................................................
Tahun Lahir : .............................................................................................................................................
Pendidikan : .............................................................................................................................................
Pekerjaan : .............................................................................................................................................
2. Nama Ibu : .............................................................................................................................................
NIK : .............................................................................................................................................
Tahun Lahir : .............................................................................................................................................
Pendidikan : .............................................................................................................................................
Pekerjaan : .............................................................................................................................................
PERIODIK

1. Tinggi Badan : .............................................................................................................................................

2. Berat Badan : ....................................................................Lingkar Kepala ……........................................
3. Jarak Tempuh : .............................................................................................................................................
4. Jumlah Saudara : .............................................................................................................................................
REGISTER

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

2. Tgl Masuk Sekolah : .............................................................................................................................................

3. No Induk Siswa : .............................................................................................................................................

4. Masuk Rombel : A / B (A .4-5 tahun / B. 5-6 tahun)

Orang Tua Siswa Orang Tua Siswa

.................................................... ....................................................