FORMULIR PENDAFTARAN
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PEMERINTAH KABUPATEN ACEH TENGAH DINAS PENDIDIKAN SEKOLAH MENENGAH KEJURUAN (SMK) NEGERI 2 TAKENGON Jln. Takengon-Isaq, Km.08 Wih Nareh Pegasing, Kode Pos : 24561 Telp/Fax : (0643) 7246451 Takengon Aceh Tengah E-mail : [email protected] FORMULIR PENDAFTARAN PENERIMAAN PESERTA DIDIK BARU (PPDB) Tahun Pelajaran 2015/2016 NOMOR PESERTA : NAMA PESERTA : ................................................... ........................................................................ .......................... NISN : ................................................... ........................................................................ .......................... TEMPAT, TANGGAL LAHIR : ................................................... ........................................................................ .......................... AGAMA : ................................................... ........................................................................ .......................... ASAL SEKOLAH : ................................................... ........................................................................ .......................... ALAMAT PESERTA : ................................................... ........................................................................ .......................... NO. TELP/HP : ................................................... ........................................................................ .......................... JURUSAN YANG DIPILIH KODE 1 2 0 2 - - 0
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Transcript of FORMULIR PENDAFTARAN
PEMERINTAH KABUPATEN ACEH TENGAHDINAS PENDIDIKANSEKOLAH MENENGAH KEJURUAN (SMK) NEGERI 2 TAKENGONJln. Takengon-Isaq, Km.08 Wih Nareh Pegasing, Kode Pos : 24561Telp/Fax : (0643) 7246451 Takengon Aceh TengahE-mail : [email protected]
FORMULIR PENDAFTARANPENERIMAAN PESERTA DIDIK BARU (PPDB) Tahun Pelajaran 2015/201602--0
NOMOR PESERTA: NAMA PESERTA: .....................................................................................................................................................NISN: .....................................................................................................................................................TEMPAT, TANGGAL LAHIR: .....................................................................................................................................................AGAMA: .....................................................................................................................................................ASAL SEKOLAH: .....................................................................................................................................................ALAMAT PESERTA: .....................................................................................................................................................NO. TELP/HP: .....................................................................................................................................................IDENTITAS SISWA: Tinggi : ............. CmBerat : ............... KgREKAP NILAI RAPORT (RENTANG NILAI 0-10)NOMATA PELAJARANNILAI/SEMESTERJUMLAH
12345
1BAHASA INDONESIA
2BAHASA INGGRIS
3MATEMATIKA
4IPA
JUMLAH TOTAL
REKAP NILAI UN MURNINOMATA PELAJARANMATA PELAJARANJUMLAH
B.INDB.INGGMMIPA
1NILAI MURNI
PRESTASI PERORANGAN :NOBIDANG PRESTASIPERINGKATTINGKATTAHUN
1
2
Keterangan :1. Melampirkan Ijazah, Melampirkan SKHUN Asli, dan Surat Keterangan Lulus Asli dari Sekolah Asal2. Pas Photo Warna 3 x 4 sebanyak 2 lembar3. Melampirkan Foto Copy Raport SMP Semester 1 s.d 5 dilegalisir4. Photo Copy Kartu Keluarga5. Biaya Test dan Map Rp. 25.000,-
Takengon, ..............................................2015PESERTA/SISWA, ORANG TUA SISWA,
.............................................. .........................................................
