Formulir Pendaftaran Calon Santri Baru

Formulir Pendaftaran Calon Santri Baru

Formulir Pendaftaran Calon Santri Baru

Formulir Pendaftaran Calon Santri Baru

Download Formulir Pendaftaran Calon Santri Baru Pondok Pesantren AL-HUDA Pakuncen Selomerto Wonosobo.

FORMULIR PENDAFTARAN CALON SANTRI BARU

DATA DIRI CALON SANTRI

1.	Nama Lengkap	: .........................................................................................
2.	Jenis Kelamin	: .........................................................................................
3.	Tempat Tanggal Lahir	: .........................................................................................
4.	Agama	: I S L A M
5.	Kewarganegaraan	: WNI
6.	Anak ke	: .........................................................................................
7.	Jumlah Saudara Kandung	: .........................................................................................

DATA TEMPAT TINGGAL

8.	Alamat	: .........................................................................................
		..........................................................................................
9.	Nomor Telephone	: .........................................................................................
10.	Tinggal dengan	: Orang Tua / Sauadara / Asrama

KETERANGAN KESEHATAN

11.	Tinggi badan (Cm) dan berat badan (Kg)	: .........................................................................................
12.	Riwayat Penyakit	: .........................................................................................
13.	Golongan Darah	: A / B / O / AB

KETERANGAN PENDIDIKAN

14.	Pendidikan sebelumnya
	a. Lulusan dari sekolah	: SD / MI / SMP / MTs ......................................................
	b. Lama belajar (tahun)	: .........................................................................................
15.	Diterima di Pondok ini pada
	a. Kelas	: .........................................................................................
	b. Tanggal	:.........................................................................................

KETERANGAN AYAH KANDUNG

16.	Nama	: .........................................................................................
17.	Tempat Tanggal Lahir	: .........................................................................................
18.	Agama	: I S L A M
19.	Kewarganegaraan	: WNI
20.	Pendidikan	: SD/SMP/SMA/S1/S2/S3/Lainnya..................................
21.	Pekerjaan	: .........................................................................................
22.	Penghasilan Perbulan	: .........................................................................................
23.	Alamat	: .........................................................................................
		............................................................................................
		............................................................................................
24.	Nomor Telephone	: .........................................................................................
25.	Masih Hidup/Meninggal Dunia	: Masih Hidup/Meninggal Dunia

KETEANGAN IBU KANDUNG

26.	Nama	: .........................................................................................
27.	Tempat Tanggal Lahir	: .........................................................................................
28.	Agama	: I S L A M
29.	Kewarganegaraan	: WNI
30.	Pendidikan	: SD/SMP/SMA/S1/S2/S3/Lainnya..................................
31.	Pekerjaan	: .........................................................................................
32.	Penghasilan Perbulan	: .........................................................................................
33.	Alamat	: .........................................................................................
		............................................................................................
		............................................................................................
34.	Nomor Telephone	: .........................................................................................
35.	Masih Hidup/Meninggal Dunia	: Masih Hidup/Meninggal Dunia

KETERANGAN WALI

36.	Nama	: .........................................................................................
37.	Tempat Tanggal Lahir	: .........................................................................................
38.	Agama	: I S L A M
39	Kewarganegaraan	: WNI
40.	Pendidikan	: SD/SMP/SMA/S1/S2/S3/Lainnya..................................
41.	Pekerjaan	: .........................................................................................
42.	Penghasilan Perbulan	: .........................................................................................
43.	Alamat	: .........................................................................................
		............................................................................................
		............................................................................................
44.	Nomor Telephone	: .........................................................................................

KEGEMARAN CALON SANTRI

45.	Kesenian	: ........................................................................................
46.	Olahraga	:.........................................................................................
47.	Kemasyarakatan/Organisasi	: ........................................................................................
48.	Lain Lain	: ........................................................................................

Demikian data pribadi ini saya isi dengan sebenar benarnya.

Wonosobo, ................................... 2024

Mengetahui;
Orang Tua/Wali	Calon Santri

(......................................)	(....................................)

Download Formulir Pendaftaran Calon Santri Baru.

Formulir Pendaftaran Calon Santri Baru.pdf 143 kb

Anda juga bisa mengisi formulir melalui Google Form di bawah ini.

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_WidgetManager._RegisterWidget('_LinkListView', new _WidgetInfo('LinkList62', 'sec_Addon_Widgets', document.getElementById('LinkList62'), {}, 'displayModeFull'));
_WidgetManager._RegisterWidget('_LinkListView', new _WidgetInfo('LinkList63', 'sec_Addon_Widgets', document.getElementById('LinkList63'), {}, 'displayModeFull'));
_WidgetManager._RegisterWidget('_HTMLView', new _WidgetInfo('HTML61', 'sec_Addon_Widgets', document.getElementById('HTML61'), {}, 'displayModeFull'));
_WidgetManager._RegisterWidget('_ImageView', new _WidgetInfo('Image61', 'sec_Addon_Widgets', document.getElementById('Image61'), {'resize': false}, 'displayModeFull'));
</script>
</body>