CONTOH FORMULIR PENDAFTARAN UNTUK SEKOLAH

 

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FORMULIR PENDAFTARAN MTs.

 

No. Induk Santri : ..........................................(diisiolehpihaksekolah)

DATA CALON SISWA

 

1.       Nama (Sesuai Akta Kelahiran)       : ..........................................................................................

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

3.       NIK                                            :

4.       Jenis Kelamin                              : £ Laki-laki   £ Perempuan )*

5.       Tempat Lahir                              : ..........................................................................................

6.       Tanggal Lahir                              :

7.       Golongan darah                          : A / B / AB / O )*

8.       Keadaan jasmani

a.    Berat badan                           : .................................................................................... kg

b.    Tinggi badan                          : .................................................................................... cm

c.    Penyakit                                : ..........................................................................................

d.   Kelainan jasmani                    : ..........................................................................................

9.       Hobi (Hal yang disukai)                : ..........................................................................................

10.   Hal yang dibenci                         : ..........................................................................................

11.   Cita-cita                                     : ..........................................................................................

12.   Anak ke- / dari                            : ..........................................................................................

13.   Status dlmkeluarga                     : AnakKandung / AnakTiri / AnakAngkat )*

14.   Jumlah saudara                           : ..........................................................................................

15.   Alamat                                       : Jalan  ...............................................................RT.... RW....

                                                   No... Kel./Desa ..................................................................

                                                 Kecamatan ........................................................................

                                                        Kab./Kota ..........................................................................

                                                        Propvinsi ............................................Kode Pos ................

16.   Tinggal Bersama                        : £ Orang Tua    £ Wali      £ Kos/Mondok    £ .................)*

17.   Jarak dari rumah ke sekolah       : ............................................................................................

18.   Tanggal mendaftar di sekolah ini  :

19.   Jika pindahan sebutkan alasan pindan ke sekolah ini : .............................................................

20.   Diterima di kelas                         : ..........................................................................................

21.   Prestasi yang pernah diraih          : Bidang ................................ Juara ke ............... Thn ........

                                                 Tingkat : Desa/Kec./Kab./Prov./Nas/Internasional )*

22.   Nomor KPS / KKS (bila ada)          : ..........................................................................................

23.   Nomor KIP (bila ada)                    : .........................................................................................

24.   Nomor PKH (bila ada)                  : .........................................................................................

 

 

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DATA SEKOLAH ASAL CALON SISWA

 

1.   NISN                                           :

2.   Nama Sekolah Asal                       : SD / MI )* ...........................................................................

3.   Status Sekolah                             : Swasta / Negeri )*

4.   NPSN Sekolah                               :

5.   Alamat Sekolah                            : Jalan  ................................................................RT.... RW....

                                                   No... Kel./Desa ...................................................................

                                                   Kecamatan .........................................................................

                                                          Kab./Kota ...........................................................................

                                                        Provinsi ...............................................Kode Pos ................

6.   Tanggal Lulus SD/MI                     :

7.   Total Nilai Ujian Nasional SD/MI     : ...........................................................................................

8.   Nomor Peserta US/UM SD/MI         : ...........................................................................................

9.   Nomor Seri Ijazah SD/MI               : ...........................................................................................

10.   Nomor Blanko SKHU SD/MI          : ...........................................................................................

DATA ORANG TUA / WALI CALON SISWA

 

1.   No. Kartu Keluarga         :

2.   Nama Ayah / Wali           : ...........................................................................................................

3.   NIK Ayah / Wali              :

4.   Pendidikan Ayah/ Wali    : £ SD  £ SLTP   £ SLTA    £ D2  £ D3   £S1 £ S2  £ S3  £ .........)*

5.   Pekerjaan Ayah / Wali     : ...........................................................................................................

6.   No. HP Ayah / Wali         :

7.   Nama Ibu                      : ...........................................................................................................

8.   NIK Ibu                          :

9.   Pendidikan Ibu               : £ SD  £ SLTP   £ SLTA    £ D2  £ D3   £S1 £ S2  £ S3  £ .........)*

10.   Pekerjaan Ibu               : ...........................................................................................................

11.   No. HP Ibu                   :

12.   Rata- rata Penghasilan Orang Tua Perbulan   :

                                  £< 500 rb               £ 600 rb – 1 jt        £ 1 jt – 1,5 jt

                                      £ 1,5 jt – 2 jt        £ 2 jt – 3 jt             £ 3 jt – 5 jt     £> 5jt)*

11.   Jumlah tanggungan      : ..........................................................................................................

12.   Hubungan dengan calon santri : ..............................................................................(jika Wali)

13.     Alamat Orang Tua/Wali   : Jalan  .........................................................................RT...... RW......

                                      No....... Kel./Desa ............................................................................

                                      Kecamatan ......................................................................................

                                             Kab./Kota .......................................................................................

                                    Provinsi .............................................................Kode Pos ................

……………….., ……………….……………….. Orang Tua/WaliCalonSantri     ( ……………………………………. )

 

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