FORMULIR PENDAFTARAN SANTRI BARU

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

Nama Panggilan : ................................................................................................................
Tempat Tanggal Lahir : ................................................................................................................
Jenis Kelamin : ..............................................................................................................
Masuk Lembaga : ................................................................................................................
Nahwu Shorof Umum
Nama Wali : Ayah: ...................................... Ibu: .......................................................
Pekerjaan Wali : ..................................................................................................................
Alamat Lengkap : ................................................... Desa / Kelurahan : ..............................
Kecamatan : .............................. Kabupaten : .......................................
Provinsi : .................................... Kode Pos: ...........................................
Nomor HP Wali : ................................................................................................................

PERSYARATAN PENDAFTARAN SANTRI BARU

1. Foto Copy Akte Kelahiran
2. Fotocopy Kartu Keluarga
3. Fotopy Ijazah atau Rapport Terakhir
4. Pas Foto 4x6

Bekasi, ......................./............../20.....

Pas Foto
4x6 ( ................................................ )
Calon Santri

Mengetahui,

( ....................................) ( ....................................)
Pengurus Ponpes Wali Santri