Formulir Ppdb 2019/2020
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YAYASAN PENDIDIKAN ISLAM MANAHIJUL HUDA ( YAPIM ) MADRASAH IBTIDAIYAH MANAHIJUL HUDA NGAGEL NGAGEL – DUKUHSETI – PATI Alamat : Jl. Kauman No.01 Ngagel Dukuhseti Pati 5915 HP. 081 325 111 446 email;[email protected]
FORMULIR PENDAFTARAN PESERTA DIDIK BARU TAHUN PELAJARAN 2019/2020 DIISI SESUAI AKTE KELAHIRAN DAN KARTU KELUARGA ( KK ) 1. 2. 3. 4. 5. 6. 7. 8. 9.
NAMA LENGKAP NAMA PANGGILAN TEMPAT TANGGAL LAHIR JENIS KELAMIN STATUS DALAM KELUARGA ANAK KE ALAMAT PESERTA DIDIK SEKOLAH ASAL NAMA ORANG TUA a. AYAH b. IBU 10. ALAMAT ORANG TUA 11. NOMOR TELEPON/HP. 12. PEKERJAAAN ORANG TUA a. AYAH b. IBU 13. NAMA WALI 14. ALAMAT WALI 15. PEKERJAAAN WALI 16. NOMOR TELEPON/HP. WALI
: .......................................................................... : .......................................................................... : .......................................................................... : .......................................................................... : .......................................................................... : .......................................................................... : .......................................................................... : .......................................................................... : .......................................................................... : .......................................................................... : .......................................................................... : .......................................................................... : .......................................................................... : .......................................................................... : .......................................................................... : .......................................................................... : .......................................................................... : .......................................................................... NGAGEL, .............................................. ORANG TUA/ WALI ................................................................
Harap menyertakan : 1. 2 lembar foto copy Akte Kelahiran 2. 2 lember foto copy Kartu Keluarga ( KK ) 3. 2 lember foto copy Ijasah TK/RA 4. 2 lembar foto copy KIP/PKH/ Jamkesmas/BPJS/sejenisnya bagi yang mempunyai
FORMULIR PENDAFTARAN PESERTA DIDIK BARU TAHUN PELAJARAN 2019/2020 DIISI SESUAI AKTE KELAHIRAN DAN KARTU KELUARGA ( KK ) 1. 2. 3. 4. 5. 6. 7. 8. 9.
NAMA LENGKAP NAMA PANGGILAN TEMPAT TANGGAL LAHIR JENIS KELAMIN STATUS DALAM KELUARGA ANAK KE ALAMAT PESERTA DIDIK SEKOLAH ASAL NAMA ORANG TUA a. AYAH b. IBU 10. ALAMAT ORANG TUA 11. NOMOR TELEPON/HP. 12. PEKERJAAAN ORANG TUA a. AYAH b. IBU 13. NAMA WALI 14. ALAMAT WALI 15. PEKERJAAAN WALI 16. NOMOR TELEPON/HP. WALI
: .......................................................................... : .......................................................................... : .......................................................................... : .......................................................................... : .......................................................................... : .......................................................................... : .......................................................................... : .......................................................................... : .......................................................................... : .......................................................................... : .......................................................................... : .......................................................................... : .......................................................................... : .......................................................................... : .......................................................................... : .......................................................................... : .......................................................................... : .......................................................................... NGAGEL, .............................................. ORANG TUA/ WALI ................................................................
Harap menyertakan : 1. 2 lembar foto copy Akte Kelahiran 2. 2 lember foto copy Kartu Keluarga ( KK ) 3. 2 lember foto copy Ijasah TK/RA 4. 2 lembar foto copy KIP/PKH/ Jamkesmas/BPJS/sejenisnya bagi yang mempunyai
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