Post on 25-Sep-2015
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FORMULIR PENDAFTARAN SISWA BARU
KEMENTERIAN AGAMA
MADRASAH ALIYAH NEGERI RANCAH
KABUPATEN CIAMIS
Jl. Rumah Sakit No. 20 Desa Situmandala Kec. Rancah Kab. Ciamis 46387 Telp/Fax. 0265 2732379
FORMULIR BIODATA SISWA MAN RANCAHMohon semua diisi dengan lengkap!NOMOR IDENTITAS
Nomor Peserta Ujian MTs/SMP: ............................................................................
NISN
: ............................................................................
Nomor STTB/Ijazah
: ............................................................................
Nomor SKHUN
: ............................................................................IDENTITAS SISWANama lengkap
: ............................................................................Jenis Kelamin
: ............................................................................
Tempat, Tgl Lahir: ............................................................................Umur
: ............................................................................Agama
: ............................................................................Hobi
: ............................................................................Cita-cita
: ............................................................................Jarak Ke Sekolah
: ............................................................................Alat Transportasi
: ............................................................................StatusKeluarga: Anak Kandung/Tiri/Lainnya)*Jumlah Saudara
: Kandung ...................................... Tiri ......................................Penerima BSM
: Ya/Bukan)*IDENTITAS ORANG TUA/WALI
Nama Orang Tua
: Ayah ...................................... Ibu ......................................Pendidikan
: Ayah ...................................... Ibu ......................................
Pekerjaan
: Ayah ...................................... Ibu ......................................Penghasilan
: Ayah ...................................... Ibu ......................................Agama
: Ayah ...................................... Ibu ......................................
Alamat
: Dusun.........................................RT/RW .......... ......No...............
Desa................................Kec. ............... ..........Kab. ...................
No. Telp/HP
: ............................................................................No. Kartu Keluarga: ............................................................................IDENTITAS SEKOLAH ASALNama Sekolah Asal
: ............................................................................................................................................Status Sekolah
: Negeri/Swasta/Paket C/Pesantren)*Alamat Sekolah
: ............................................................................................................................................Tanggal/Bulan/Tahun Lulus: ............................................................................................................................................Nilai Rata-rata Ujian
: ............................................................................................................................................PRESTASI YANG DIMILIKI
Bidang Akademis
: ............................................................................................................................................Bidang Olah Raga
: ............................................................................................................................................Bidang Kesenian
: ............................................................................................................................................Bidang Keagamaan
: ............................................................................................................................................Bidang Lainnya
: ............................................................................................................................................)* coret yang tidak perlu
Mengetahui :
Orang Tua/ Wali Siswa
.............................................................................................., ..............................2014Siswa,
..............................................................
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