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,

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Karawang, ................................ 2013

Calon Siswa,

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