MADRASAH TSANAWIYAH

NURUL QOMAR TAWANGREJO

NSM : 121216080007 NPSN :10648685
Alamat : Jalan Garuda Desa Tawangrejo, Kec.Belitang Kab. OKU Timur

FORMULIR PENDAFTARAN

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

2. Tempat Tanggal Lahir : ................................................................................................

3. Jenis Kelamin : ................................................................................................

4. Asal Sekolah : ................................................................................................

5. NISN : ................................................................................................

6. Anak Ke : Dari Saudara

7. Nama Orang Tua

a. Ayah : ................................................................................................

b. Ibu : ................................................................................................

8. Pekerjaan Orang Tua

a. Ayah : ................................................................................................

b. Ibu : ................................................................................................

9. No telepon/HP yang dapat dihubungi

a. Anak : ................................................................................................

b. Ayah : ................................................................................................

c. Ibu : ................................................................................................

10. Alamat Rumah : ................................................................................................

Syarat pendaftaran
1. Fotocopy Ijazah atau Surat Keterangan Lulus
2. Fotocopy KK
3. Fotocopy akta kelahiran

Orang Tua/ Wali Calon Siswa/Siswi

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