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FORMULIR DAFTAR ULANG TAHAP 1
DITULIS DENGAN HURUF KAPITAL
Silahkan isi formulir dibawah sebagai bukti bahwa anda diterima di MTsN 1 Kota Blitar pada jalur prestasi akademik dan non akademik / Golden tiket tahun pelajaran 2022-2023
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NOMOR KARTU PESERTA
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NISN
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NAMA LENGKAP (TIDAK DISINGKAT)
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ASAL SEKOLAH
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NIK SISWA
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TEMPAT / TANGGAL LAHIR
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JENIS KELAMIN
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LAKI-LAKI
PEREMPUAN
JUMLAH SAUDARA
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ANAK KE
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1
2
3
4
5
STATUS DALAM KELUARGA
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Anak Kandung
Anak Tiri
ANak Angkat
ALAMAT SISWA
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NO TELP SISWA
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NAMA AYAH
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NIK AYAH
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PENDIDIKAN AYAH
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PEKERJAAN AYAH
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NO TELP AKTIF/WA AYAH
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NAMA IBU
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NIK IBU
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PENDIDIKAN IBU
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PEKERJAAN IBU
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NO TELP AKTIF/WA IBU
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ALAMAT ORANG TUA
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NAMA WALI (Jika ada)
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PEKERJAAN WALI
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ALAMAT WALI
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NO TELP WALI
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