FORMULIR PENDAFTARAN

Yayasan Pendidikan Pondok Pesantren Salaffiyah Ar Rahmah

SMK  AR RAHMAH

Nglawan Senden Peterongan Jombang Jawa Timur

NSS. 20405040064   NPSN. 20574775   Telp. 0321 7428069

FORMULIR PENDAFTARAN

No : ................................

IDENTITAS CALON SISWA BARU

1.      Nama Lengkap                  : .......................................................................................................

2.      NISN                                : .......................................................................................................

3.      Jenis Kelamin                    : .......................................................................................................

4.      Tempat, Tgl Lahir             : .......................................................................................................

5.      Anak Ke                            : .......................................................................................................

6.      Asal sekolah                      : .......................................................................................................

7.      Jumlah Saudara                 : .......................................................................................................

8.      Alamat Tempat Tinggal    : .......................................................................................................

IDENTITAS ORANG TUA

1.      Nama Orang Tua

Ayah                                 : .......................................................................................................

Ibu                                     : .......................................................................................................

2.      Pendidikan Orang Tua

Ayah                                 : .......................................................................................................

Ibu                                     : .......................................................................................................

3.      Pekerjaan orang tua

Ayah                                 : .......................................................................................................

Ibu                                     : .......................................................................................................

4.      Alamat                              : .......................................................................................................

Persyaratan Pendaftaran

‚          Mengisi Formulir Pendaftaran

‚          Fotocopy Ijazah/STTB SD/MI 2 lembar

‚          Pas foto hitam putih 3x4 2 lembar

Masuk di kelas                        : .......................................................................................................

PETERONGAN,.................................20..............

PANITIA PSB _________________

PAS FOTO 3X4

CALON SISWA BARU ___________________