Post on 15-Jan-2016
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YAYASAN PENDIDIKAN DASAR DAN MENENGAH (YPDM) PASUNDAN
SEKOLAH MENENGAH KEJURUAN
SMK PASUNDAN CILAMAYA KP. BABAKAN DSN. V DESA SUMURGEDE KEC. CILAMAYA KULON KARAWANG
KELOMPOK TEKNOLOGI DAN INDUSTRI
STATUS TERAKREDITASI “B”
FORMULIR PENDAFTARAN SISWA BARU
SMK PASUNDAN CILAMAYA
A. DATA CALON SISWA BARU
1. Nama : ...........................................................................................................
2. Tempat, Tanggal Lahir : ...........................................................................................................
3. Jenis Kelamin : Laki-laki Perempuan
4. Alamat : ...........................................................................................................
...........................................................................................................
...........................................................................................................
5. Kendaraan ke Sekolah : ...........................................................................................................
6. Agama : ...........................................................................................................
7. Asal Sekolah : ...........................................................................................................
8. Tahun Lulus : ...........................................................................................................
B. DATA KELUARGA
1. Nama Orang Tua / Wali : ...........................................................................................................
2. Alamat : ...........................................................................................................
...........................................................................................................
...........................................................................................................
3. Telepon / HP Orang Tua : ...........................................................................................................
4. Pekerjaan : ...........................................................................................................
5. Penghasilan per Bulan : < 1 Juta 1 s/d 5 Juta > 5 Juta
6. Alasan Memilih : ...........................................................................................................
SMK Pasundan Cilamaya ...........................................................................................................
...........................................................................................................
C. PROGRAM STUDI YANG DIPILIH
1. Rekayasa Perangkat Lunak (RPL) 2. Teknik Sepeda Motor (TSM)
Mengetahui :
Orang Tua / Wali,
_________________________
Karawang, ................................ 2013
Calon Siswa,
_________________________
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