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FORMULIR PENDAFTARAN SISWA/i BARU SMK KESEHATAN REFORMASI PONTIANAK TAHUN AJARAN 2021/2022
Jl. Purnama Agung VII Blok CII- 13 IZIN Operasional: 877 AKREDITASI BAN-S/M: B NPSN: 69947508
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Nama Lengkap
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NISN
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Tempat / Tanggal Lahir
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Jenis Kelamin
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Laki - Laki
Perempuan
Agama
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Kewarganegaraan
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Jumlah Saudara
1
2
3
4
5
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Dalam KK Urutan Anak Ke Berapa
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2
3
4
5
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Jarak Dari Rumah Ke Sekolah (KM)
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Alamat Tinggal Sekarang
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No HP yang bisa Dihubungi
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Asal Sekolah
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No. Hp Ayah/Ibu
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Pilihan Jurusan
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Keperawatan
Farmasi
Pekerjaan Ayah
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Penghasilan Orang Tua Ayah + Ibu per bulan
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500.000 - 1.500.000
1.600.000 - 2.500.000
2.600.000 - 3.500.000
4.000.000 - 20.000.000
Apakah punya KIP, KPS, PKH (apabila menerima tuliskan nomernya)
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Tinggi Badan
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Berat Badan
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