PENERIMAAN PESERTA DIDIK BARU SMPN2 SELAT TAHUN PELAJARAN 2014/2015

PENERIMAAN PESERTA DIDIK BARU SMPN2 SELAT TAHUN PELAJARAN 2014/2015

A. SPANDUK PSB 2014/2015

B. FORMULIR PENDAFTARAN

PEMERINTAH KABUPATEN KAPUAS

DINAS PENDIDIKAN 

SMP NEGERI 2 SELAT

Jln. Jend. Sudirman No. 170 Telp. (0513) 21097 Kuala Kapuas

E-mail: smpn2selat@gmail.com http://smpnegeri2selat.blogspot.com/

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FORMULIR PENDAFTARAN PESERTA DIDIK BARU

TAHUN PELAJARAN 2014/2015

Nomor Pendaftaran              : …………………………………………………………….

Nama Siswa                           : ............................................................................................

Jenis Kelamin                          : ……………………………………………………………

Tempat, Tanggal Lahir            : ............................................................................................

Agama                                     : ............................................................................................

Alamat Siswa                          : ...........................................................................................

Sekolah Asal                          : ............................................................................................

Jumlah Nilai Ujian Nasional   : ............................................................................................

STTB/Ijazah SD/MI Tahun     : ............................................................................................

Nomor STTB/Ijazah SD/MI   : ............................................................................................

Orang Tua

            a. Ayah                        : ............................................................................................

            b. Ibu                           : ............................................................................................

Alamat Orang Tua                  : ............................................................................................

No HP/Telepon Orang Tua     : ............................................................................................

Pekerjaan Orang Tua

            a. Ayah                        : ............................................................................................

            b. Ibu                           : ............................................................................................

Nama Wali                             : ............................................................................................

Alamat Wali                            : ............................................................................................

No HP/Telepon Wali               : ............................................................................................

Pekerjaan Wali                        : ............................................................................................

Prestasi yang Pernah Diraih

            1 ..........................................................................................

            2 ..........................................................................................

            3 ..........................................................................................

            4 ..........................................................................................

           

                                                                                    Kuala Kapuas, ………………

                                                                                    Orang Tua/Wali,

                                                                                    ……………………………