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PRA PENDAFTARAN PESERTA DIDIK BARU
NAMA LENGKAP
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JENIS KELAMIN
PRIA
WANITA
NISN
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TEMPAT LAHIR
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TANGGAL LAHIR
MM
/
DD
/
YYYY
NIK
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AGAMA
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ISLAM
KRISTEN
HINDU
BUDHA
KHONGHUCU
KEPERCAYAAN
ALAMAT
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JENIS TINGGAL
BERSAMA ORANG TUA
BERSAMA WALI
ALAT TRANSPORTASI
SEPEDA
MOTOR
MOBIL
NOMOR TELEPHONE/HP
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E-MAIL
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PENERIMA KIP
YA
TIDAK
BERAT BADAN
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TINGGI BADAN
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JARAK RUMAH KE SMAN 1 LIGUNG
KURANG DARI 5 KM
LEBIH DARI 5 KM
JUMLAH SAUDARA KANDUNG
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ASAL SEKOLAHÂ
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