Formulir Psb
1
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, _________________________ Foto terbaru 3 x 4 4 lembar berwarna
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Transcript of Formulir Psb
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,
_________________________
Foto terbaru
3 x 4
4 lembar
berwarna
