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FORMULIR PENERIMAAN PESERTA DIDIK BARUSMAN 9 KUNINGAN
TAHUN 2015Alamat : Jl. Lingkar Kadugede No. 2 Kuningan - Jawa Barat Telp : 0232-875847
Email : [email protected] - Website : http://sman9kuningan.sch.id
Nomor Pendaftaran : *............................................................................................Tanggal Pendaftaran : *............................................................................................Jalur Pendaftaran : .............................................................................................Nama Calon Peserta Didik : .............................................................................................Tempat, Tanggal Lahir : .............................................................................................Jenis Kelamin : .............................................................................................Agama : .............................................................................................Status dalam Keluarga : .............................................................................................Anak ke : .............................................................................................Alamat : .............................................................................................Nomor Telepon : .............................................................................................Email : .............................................................................................Sekolah Asal : .............................................................................................Nama Ayah : .............................................................................................Nama Ibu : .............................................................................................Alamat Orang Tua : .............................................................................................Nomor Telepon Orang Tua : .............................................................................................Pekerjaan Ayah : .............................................................................................Pekerjaan Ibu : .............................................................................................Nama Wali : .............................................................................................Alamat Wali : .............................................................................................Nomor Telepon Wali : .............................................................................................Pekerjaan Wali : .............................................................................................
Calon Peserta Didik, Kuningan,......................................... 2015
Panitia PPDB,
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Ket : Isian dengan tanda (*) diisi oleh panitia PPDB
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