FORMULIR PENDAFTARAN PESERTA DIDIK BARU
SMK SBP ROUDLOTUS SAIDIYYAH SEMARANG
TAHUN PELAJARAN 2018/2019
1. DATA PRIBADI
Nama Lengkap *
Your answer
Jenis Kelamin *
NISN *
Your answer
NIK *
Your answer
Tempat, Tanggal Lahir *
Your answer
Agama *
Your answer
Asal Sekolah (SD/MI/SMP/MTs) *
Your answer
Catatan Prestasi
Your answer
Alamat Tinggal (RT/RW) *
Your answer
Kelurahan/Desa *
Your answer
Kecamatan *
Your answer
Kode Pos *
Your answer
Jenis Tinggal *
Alat Transportasi ke Sekolah *
No. Telepon Rumah/Hp *
Your answer
Email Pribadi
Your answer
Apakah Penerima KPS *
Nomor KPS
Your answer
Program Studi yang dipilih (SMK) *
Required
Status Siswa/Santri (SMP/SMK) *
Required
2. DATA AYAH KANDUNG
Nama Ayah :
Your answer
Tahun Lahir :
Your answer
Pendidikan :
Your answer
Pekerjaan
Your answer
Penghasilan Perbulan *
DATA Ibu Kandung
Nama Ibu:
Your answer
Tahun Lahir
Your answer
Pendidikan:
Your answer
Pekerjaan
Your answer
Penghasilan Perbulan *
Orang Tua/Wali: *
Your answer
Tanggal Pendaftaran
MM
/
DD
/
YYYY
Rekomendasi dari: *
Your answer
No Telpon/HP
Your answer
YAYASAN ROUDLOTUS SAIDIYYAH
Jl. Kalialang baru, Sukorejo, Gunungpati Kota Semarang

Telp: 024-76433666
HP:
Diah Iswanti, S.Pd (08112708340)
Akhmad Yusuf, S.S. (085741189585)

Email:smk.is.rosa@gmail.com

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