Formulir PPDB 2017/2018

Formulir Pendaftaran BA Aisyiyah Putat Tahun Pelajaran 2017/2018

 

FORMULIR PENERIMAAN PESERTA DIDIK BARU

BA AISYIYAH PUTAT TAHUN PELAJARAN 2017/2018

A.      KETERANGAN CALON PESERTA DIDIK

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

2.       Nama Panggilan                                        :     ..................................................................................

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

4.       Tempat/ Tgl Lahir                                      :     ..................................................................................

5.       Anak ke                                                        :     .................................................................................. .......

6.       Status dalam keluarga                            :     ..................................................................................

7.       Jumlah saudara Kandung                      :     ..................................................................................

8.       Alamat tempat Tinggal                           :     ..................................................................................

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

9.       No.Telp/HP yang bisa di Hub               :     ..................................................................................

B.      KETERANGAN BAKAT DAN MINAT CALON PESERTA DIDIK

1.       Hobi                                                               :     ..................................................................................

2.       Prestasi yang pernah di raih                 :     ..................................................................................

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

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

C.      KETERANGAN ORANG TUA KANDUNG

1.       Nama Lengkap

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

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

2.       Tempat Tgl. Bln. Thn. Lahir

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

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

3.       Pekerjaan

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

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

4.       Alamat Tempat Tinggal                           :     Dk……………………………………..RT………..RW……………………..

                                                                               Kec……………………………………Kab……………………………………

5.       Penghasilan rata-rata perbulan

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

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

6.       Keterangan

a.       Ayah                                                     :     (Masih hidup/Meninggal tahun................................... )*

b.      Ibu                                                        :     (Masih hidup/Meninggal tahun................................... )*

7.       Apakah memiliki Kartu

Keluarga Miskin/KPS (Kartu

Perlindungan Sosial/PKH)                     :     (Ya/Tidak)*

*) coret yang tidak perlu

                                                                                                                                                                                                                                                                                                                Boyolali,…………………………..

                                                                                                                                        OrangTua/Wali Murid

                                                                                                                                        (…………………………………)

Nomor Pendaftaran       :…………………….(Di isi petugas PPDB) :…………………………………….

                                                                                                                   (nama petugas pendaftar)

Download