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Penerimaan Santri Baru Al-Qur'an Center Ummu Habibah 2024/2025
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IDENTITAS CALON SANTRI
IDENTITAS CALON SANTRI
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Nama Lengkap Anak
Nama Lengkap Anak
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Nama Panggilan
Nama Panggilan
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Tempat Lahir
Tempat Lahir
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Tanggal Lahir
Tanggal Lahir
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Daftar Sebagai
Daftar Sebagai
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Santri baru (kelas 1)
Santri mutasi (pindahan)
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Daftar ke kelas
Daftar ke kelas
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Kelas 4
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Anak ke .....
Anak ke .....
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Dari ..... bersaudara
Dari ..... bersaudara
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RIWAYAT KESEHATAN
RIWAYAT KESEHATAN
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Tinggi Badan
Tinggi Badan
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dalam cm
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Berat Badan
Berat Badan
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dalam kg
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Golongan Darah
Golongan Darah
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A
B
AB
O
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Mata
Mata
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Berkacamata
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Riwayat Penyakit
Riwayat Penyakit
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tuliskan diagnosa, tahun, dan keterangan (di-opname atau tidak)
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Riwayat Imunisasi
Riwayat Imunisasi
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DPT, Polio, Hepatitis, BCG, meningitis, Campak, MMR, HIB, lain lain
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Kebiasaan Baik
Kebiasaan Baik
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Kebiasaan Buruk
Kebiasaan Buruk
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KEPRIBADIAN
KEPRIBADIAN
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Hobi
Hobi
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Karakter yang Menonjol
Karakter yang Menonjol
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Potensi dan Bakat
Potensi dan Bakat
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Prestasi yang Pernah Diraih
Prestasi yang Pernah Diraih
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Kebiasaan di Rumah
Kebiasaan di Rumah
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Hiburan di Rumah
Hiburan di Rumah
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TV
Komputer
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RIWAYAT PENDIDIKAN
RIWAYAT PENDIDIKAN
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Sekolah Terakhir
Sekolah Terakhir
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TK
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Nama Sekolah
Nama Sekolah
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Alamat Sekolah
Alamat Sekolah
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DATA ORANG TUA
DATA ORANG TUA
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Nama Lengkap Ayah
Nama Lengkap Ayah
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Tanggal Lahir Ayah
Tanggal Lahir Ayah
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Pendidikan Terakhir Ayah
Pendidikan Terakhir Ayah
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SD
SMP
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S1
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S3
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Alamat Rumah Ayah
Alamat Rumah Ayah
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No Telp Rumah Ayah
No Telp Rumah Ayah
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No HP Ayah
No HP Ayah
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Pekerjaan Ayah
Pekerjaan Ayah
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Kemahiran Ayah
Kemahiran Ayah
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Instansi Tempat Ayah Bekerja
Instansi Tempat Ayah Bekerja
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E-mail Ayah
E-mail Ayah
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Nama Lengkap Ibu
Nama Lengkap Ibu
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Tanggal Lahir Ibu
Tanggal Lahir Ibu
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Pendidikan Terakhir Ibu
Pendidikan Terakhir Ibu
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S3
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Alamat Rumah Ibu
Alamat Rumah Ibu
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tulis "idem" bila sama dengan alamat rumah Ayah
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No Telp Rumah Ibu
No Telp Rumah Ibu
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tulis "idem" bila sama dengan no telp rumah Ayah
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No HP Ibu
No HP Ibu
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Pekerjaan Ibu
Pekerjaan Ibu
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Instansi Tempat Ibu Bekerja
Instansi Tempat Ibu Bekerja
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tulis "rumah" bila Ibu adalah Ibu rumah tangga
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Kemahiran Ibu
Kemahiran Ibu
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E-mail Ibu
E-mail Ibu
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Informasi yang diketahui Tentang Al-Qur'an Center Ummu Habibah
Informasi yang diketahui Tentang Al-Qur'an Center Ummu Habibah
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Alasan Ayah Memasukkan Santri ke Pesantren
Alasan Ayah Memasukkan Santri ke Pesantren
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Alasan Ibu memasukkan Santri ke Pesantren
Alasan Ibu memasukkan Santri ke Pesantren
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Dari Mana Mendapatkan Informasi Penerimaan Santri Baru Al-Qur'an Center Ummu Habibah
Dari Mana Mendapatkan Informasi Penerimaan Santri Baru Al-Qur'an Center Ummu Habibah
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Guru/pengurus Al-Qur'an Center Ummu Habibah
Wali Santri
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