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Formulir Penerimaan Santri Baru
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Nama Lengkap
*
Your answer
NISN
Your answer
Tempat Lahir
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Tanggal Lahir
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MM
/
DD
/
YYYY
Agama
Your answer
Alamat Lengkap
Your answer
Asal Sekolah
Your answer
Jenjang Pendidikan yang dipilih
*
SMP Islam Terpadu
SMK YANUBA
Program yang dipilih
*
3 tahun
6 Tahun
Nama Ayah
Your answer
Nama Ibu
Your answer
Tanggal lahir Ayah
MM
/
DD
/
YYYY
Tanggal Lahir Ibu
MM
/
DD
/
YYYY
Pekerjaan Ayah
Your answer
Pekerjaan Ibu
Your answer
Alamat Orang Tua
Your answer
Nomor Hp
Your answer
Penerima KPS/PKH/KIS
Ya
Tidak
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