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FORMULIR PENDAFTARAN PESERTA DIDIK MAN 5 JOMBANG 2019/2020
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* Indicates required question
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NISN :
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Your answer
NIK (Nomor Induk Kependudukan) :
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Your answer
NAMA LENGKAP SISWA :
*
Your answer
TEMPAT LAHIR :
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TANGGAL LAHIR :
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MM
/
DD
/
YYYY
JENIS KELAMIN
*
LAKI - LAKI
PEREMPUAN
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HOBI :
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CITA - CITA :
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JUMLAH SAUDARA :
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JALAN, DUSUN, RT/RW
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DESA/KELURAHAN :
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KECAMATAN :
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KABUPATEN
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PROVINSI :
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KODE POS
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JARAK TEMPAT TINGGAL DENGAN MADRASAH ( KM )
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TRANSPORTASI YANG DI GUNAKAN
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NOMOR KARTU KELUARGA ( KK )
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NAMA LENGKAP AYAH
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NIK ( NOMER INDUK KEPENDUDUKAN )
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PENDIDIKAN TERAKHIR :
*
SD
SMP/MTs
SMA/MA
S1
S2
Required
PEKERJAAN :
*
TANI
TNI/POLRI
SWASTA
PNS
DAGANG
LAINNYA
Required
NAMA LENGKAP IBU :
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NIK ( NOMOR INDUK KEPENDUDUKAN )
*
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PENDIDIKAN TERAKHIR
*
SD/MI
MTs/SMP
MA/SMU
S1
S2
Required
PEKERJAAN
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RATA-RATA PENGHASILAN ORANGTUA PERBULAN
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NOMER KARTU KKS/KPS
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NOMOR KARTU PKH
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NOMOR KARTU INDONESIA PINTAR (KIP)
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NAMA SEKOLAH/MADRASAH :
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ALAMAT SEKOLAH/MADRASAH
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NOMOR PESERT UN SISWA
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NOMOR BLANKO SKHUN
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NOMER IJAZAH :
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TOTAL NILAI UN
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