JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
FORM DAPODIK 2021
* Indicates required question
Email
*
Your email
NO Presensi (absen di kelas)
*
Your answer
Kelas
*
Choose
X MIPA1
X MIPA2
X MIPA3
X MIPA4
X IPS1
X IPS2
X IPS3 (KKO)
NAMA (Huruf Kapital sesuai Akta Lahir)
*
Your answer
JENIS KELAMIN
*
Choose
Laki-laki
Perempuan
NISN (10 Digit)
*
Your answer
NIK ( 16 Digit) ada di KK
*
Your answer
No kk ( 16 Digit) ada di atas KK
*
Your answer
TEMPAT LAHIR
*
Your answer
TANGGAL LAHIR
*
di isikan sesuai Ijazah, Akta lahir
MM
/
DD
/
YYYY
NO AKTA LAHIR (lihat di akta lahir)
*
Your answer
AGAMA
*
Choose
Islam
Katolik
Kristen
Hindu
Budha
Khong hu chu
Aliran Kepercayaan
Kewarganegaraan
*
Choose
Indonesia
WNA
Berkebutuhan Khusus
*
Tidak
Tuna netra A
Tuna rungu B
Tuna grahita C
Tuna daksa D
Tuna wicara F
Hiperaktif
Autis
Sekolah Asal
*
Your answer
Anak ke
*
Choose
1
2
3
4
5
6
7
8
NO IJAZAH (isikan bila sudah terbit)
dengan format DN-04 DI/xx xxxxxxx
Your answer
Alamat lengkap dengan RT RW
*
Your answer
Kode POS
Your answer
tempat tinggal
*
bersama orang tua
kos
asrama
wali
Other:
Moda Transportasi
*
Jalan Kaki
kendaraan Pribadi
kendaraan umum
Other:
NO KKS bila ada
Your answer
Penerima PKS/PKH
ya
tidak
No PKS/PKH bila menerima
Your answer
Penerima KIP
*
ya
tidak
NO KIP bila menerima
Your answer
Nama Tertera di KIP
Your answer
terima fisik Kartu KIP
ya
tidak
Clear selection
Next
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Report Abuse
-
Terms of Service
-
Privacy Policy
Forms
