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DATA PRIBADI
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Email
*
Your email
Nomor Pendaftaran PPDB
*
Your answer
Nama Lengkap
*
Gunakan Huruf Kapital
Your answer
Nama Panggilan
Your answer
Jenis Kelamin
*
Laki-laki
Perempuan
NISN
*
Nomor Induk Siswa Nasional
Your answer
NIK
*
Nomor Induk Kependudukan
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Nomor Kartu Keluarga
Your answer
Tempat Lahir
*
Your answer
Tanggal Lahir
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MM
/
DD
/
YYYY
Nomor Registrasi Akta Lahir
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Agama
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Choose
Islam
Katholik
Kristen
Hindu
Budha
Konghucu
Lainnya
Kewarganegaraan
*
Your answer
Suku
Your answer
Bahasa
*
Your answer
Berkebutuhan Khusus
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Tidak Ada
Netra (A)
Rungu (B)
Grahita Sedang (C1)
Grahita Ringan (C)
Daksa Sedang (D1)
Daksa Ringan (D)
Laras (E)
Wicara (F)
Hiperaktif (H)
Cerdas Istimewa (I)
Kesulitan Belajar (K)
Narkoba (N)
Indigo (O)
Down Syndrome (P)
Autis (Q)
Alamat Jalan
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RT
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RW
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Nama Dusun
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Desa/Kelurahan
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Kecamatan
*
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Kode Pos
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Titik Koordinat Tempat Tinggal
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Tempat Tinggal
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Bersama Orang Tua
Wali
Kost
Asrama
Panti Asuhan
Lainnya
Moda Transportasi
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Jalan kaki
Angkutan umum/bus/pete-pete
Mobil/bus antar jemput
Kereta Api
Ojek
Andong/bendi/sado/dokar/delman/becak
Peharu penyebrangan/rakit/getek
Kuda
Sepeda
Sepeda motor
Mobil pribadi
Lainnya
Nomor Telepon Rumah
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Nomor HP / WhatsApp
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Email
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Nomor KIP
Kartu Indonesia Pintar
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Nomor KIS
Kartu Indonesia Sehat
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Nomor KPS
Kartu Perlindungan Sosial
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Nomor Kartu PKH
Program Keluarga Harapan
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Nomor KKS
Kartu Keluarga Sejahtera
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Tanggal Diterima
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MM
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DD
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YYYY
Sekolah Asal
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Nomor Peserta Ujian Nasional SMP/MTs
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Nomor Seri Ijazah SMP/MTs
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