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Form Pendaftaran Santri Baru Al Azhaar 2012/2013
LPI Al Azhaar Tulungagung, Jl. Pahlawan III/40, Ds/Kec. Kedungwaru Tulungagung 66224
Telp. 0355-335600 Fax. 0355-322357 email :
al_azhaar@telkom.net
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* Indicates required question
Nama Pendaftar
*
(Nama Orang Tua / Wali)
Your answer
Nama Calon Santri
*
(Nama calon santri)
Your answer
Tempat/Tgl. Lahir
*
Your answer
Jenis Kelamin Calon Siswa
*
Choose
Laki-laki
Perempuan
Mendaftar Jenjang
*
(Pilih Jenjang yg akan dimasuki)
Choose
PAUD
TK
SD
SMP
SMA
Alamat Lengkap Pendaftar / Calon
(Alamat Pendaftar / Calon Santri)
Your answer
Telp/HP
*
(Telp & HP yang aktif)
Your answer
Catatan / Pertanyaan / Saran / Masukan
(Silakan hal yang harus kami perhatikan -ttg calon santri, ato hal lain-)
Your answer
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