lembar Pendaptaran Peserta didik Baru

1. A. IDENTITAS SISWA
1. Nama Murid
a. Lengkap : .....................................................................
b. Panggilan : .....................................................................
2. JenisKelamin : .....................................................................
3. Tempat,Tgl Lahir : .....................................................................
4. Agama : .....................................................................
5. Kewarganegaraan : .....................................................................
6. JumlahSaudara : .....................................................................
a. Kandung : .....................................................................
b. Tiri : .....................................................................
c. Angkat : .....................................................................
7. Bahasa sehari – hari di rumah : .....................................................................
8. GolonganDarah : .....................................................................
9. Alamatdan NomorTelpon : .....................................................................
10. Bertempattinggal pada : .....................................................................
11. Jarak Sekolah : .....................................................................
B. IDENTITAS ORANG TUA /WALI MURID
12. Nama orangtua kandung
a. Nama Ayah : .....................................................................
b. Nama Ibu : .....................................................................
13. PendidikanTertinggi
a. Ayah : .....................................................................
b. Ibu : .....................................................................
14. Pekerjaan
a. Ayah : .....................................................................
b. Ibu : .....................................................................
15. Alamatorang tua kandung : .....................................................................
16. Wali Murid : .....................................................................
a. Nama : .....................................................................
b. Hubungankeluarga : .....................................................................
c. Pendidikantertinggi : .....................................................................
d. Pekerjaan : .....................................................................
PEMERINTAH KABUPATEN CIANJUR
PUSAT PEMBINAAN PENDIDIKAN TK/SD KECAMATAN
CIKALONGKULON
SEKOLAH DASAR NEGERI CIJAGANG I
Alamat : Kp. Majalaya RT/RW. 01/01 . Desa. Cijagang Kec. Cikalongkulon - Cianjur
FORMULIR PENDAFTARAN CALON SISWA BARU
SDN CIJAGANG I TAHUN 2016/2017
Kelengkapanyang harus dikumpulkan
1. FotoCopy KTP
2. FotoCopy KPS
3. FotoCopy KartuKeluarga
4. FotoCopy Akte
Cijagang, .................................
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(Penerima)