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Pendaftaran Santri MDT Khoiriyah 2019
Pendaftaran Santri MDT Khoiriyah 2019/2020 Syawal 1440/1441
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* Indicates required question
Identitas Santri
Nama:
*
Isilah nama lengkap calon santri, Contoh: Ahmad Sofiyudin
Your answer
Tempat Lahir:
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Isilah tempat lahir sesuai dengan KK contoh: Bantul
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Tanggal Lahir
*
Pilihlah tanggal lahir atau ketik langsung dengan format Bulan, tgl, tahun, Contoh: 06/30/2012
MM
/
DD
/
YYYY
Alamat:
*
Isilah alamat tempat tinggal sekarang
Your answer
Sekolah/Madrasah/TK/RA:
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Isilah sekolah / madrasah formal sekarang, Contoh: MI Sananul Ula Piyungan
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Kelas:
*
TK/Paud
Kelas 1-2
Kelas 3-4
Kelas 5-6
SMP-SMA
Jenis kelamin:
*
Laki-Laki
Perempuan
Identitas Orangtua / Wali
Nama Orangtua/Wali:
*
Your answer
Alamat Orangtua:
Your answer
Nomor HP:
*
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Pekerjaan Orangtua/Wali
PNS
Petani
Pedagang
Pengusaha
Other:
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