Section 1 of 7
FORMULIR PENDAFTARAN SISWA/I SMK GUMATI MULYA BOGOR TAHUN PELAJARAN 2025/2026
Section 2 of 7
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A. KETERANGAN PRIBADI
A. KETERANGAN PRIBADI
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Nama Lengkap
Nama Lengkap
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Nomor Induk Kependidikan
Nomor Induk Kependidikan
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Nama Panggilan
Nama Panggilan
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Jenis Kelamin
Jenis Kelamin
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Nomor Induk Siswa Nasional
Nomor Induk Siswa Nasional
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Tempat Lahir
Tempat Lahir
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Tanggal Lahir
Tanggal Lahir
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Agama
Agama
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Kewarganegaraan
Kewarganegaraan
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Alamat
Alamat
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Anak Ke -
Anak Ke -
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Jumlah Saudara
Jumlah Saudara
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Tinggal Dengan
Tinggal Dengan
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Bahasa Sehari - hari
Bahasa Sehari - hari
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Jarak Dari Tempat Tinggal
Jarak Dari Tempat Tinggal
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No. Kartu Perlindungan Sosial (KPS) *jika ada
No. Kartu Perlindungan Sosial (KPS) *jika ada
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No. Kartu Program Keluarga Harapan (PKH) *jika ada
No. Kartu Program Keluarga Harapan (PKH) *jika ada
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Section 3 of 7
B. KETERANGAN PENDIDIKAN SEBELUMNYA
Asal Sekolah
Asal Sekolah
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SMP
Mts
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Tanggal Nomor Ijazah
Tanggal Nomor Ijazah
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Lamanya Belajar
Lamanya Belajar
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Pindahan Dari Sekolah
Pindahan Dari Sekolah
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Diterima Di Sekolah Ini Tanggal
Diterima Di Sekolah Ini Tanggal
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Alasan Pindah
Alasan Pindah
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Section 4 of 7
C. KETERANGAN ORANG TUA / WALI
Nama Ayah
Nama Ayah
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Nama Ibu
Nama Ibu
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Pekerjaan Orang Tua / Wali
Pekerjaan Orang Tua / Wali
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Penghasilan Orang Tua
Penghasilan Orang Tua
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Kurang Dari 1.000.000
1.000.000 - 3.000.000
Lebih Dari 3.000.000
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Agama Orang Tua / Wali
Agama Orang Tua / Wali
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Kartu Tanda Penduduk (KTP)
Kartu Tanda Penduduk (KTP)
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Ada
Tidak Ada
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Alamat Orang Tua / Wali
Alamat Orang Tua / Wali
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Section 5 of 7
D. SURAT PERNYATAAN
Nama Lengkap
Nama Lengkap
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Nomor Induk Kependudukan
Nomor Induk Kependudukan
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Tempat, Tanggal Lahir
Tempat, Tanggal Lahir
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Alamat
Alamat
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Jenis Kelamin
Jenis Kelamin
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Nomor Induk Siswa Nasional (NISN)
Nomor Induk Siswa Nasional (NISN)
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Agama
Agama
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Asal Sekolah
Asal Sekolah
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Pilihan Jurusan
Pilihan Jurusan
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Perhotelan
Tata Boga
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Pilihan Ekstrakurikuler
Pilihan Ekstrakurikuler
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Paskibra
Pramuka
PMR
Futsal
Dance
Decoration Cake
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Nama Orang Tua/Wali
Nama Orang Tua/Wali
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Nomor KTP Orang Tua/Wali
Nomor KTP Orang Tua/Wali
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Alamat Orang Tua/Wali
Alamat Orang Tua/Wali
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Nomor Telepon/HP
Nomor Telepon/HP
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Agama Orang Tua/Wali
Agama Orang Tua/Wali
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Pekerjaan Orang Tua/Wali
Pekerjaan Orang Tua/Wali
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Section 6 of 7
Dengan ini menyatakan bersungguh - sungguh dalam mengisi formulir pendaftaran siswa/i SMK Gumati Mulya Bogor Tahun Pendidikan 2025/2026
Section 7 of 7
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