8/17/2019 Formulir Pendaftaran & Data Santri

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FORMULIR PENDAFTARAN DAN DATA IDENTITAS SANTRIWAN-SANTRIWATI

PONPES AS-SALAFY “NURUL ULUM”SEMBUNGAN, UNGARAN BARAT, KAB. SEMARANG

Nomor Pend!"rn #$$$$$$$$$$$$$$$$$$$$$$    Pendaftaran Santri Baru

Tn%%& Pend!"rn #$$$$$$$$$$$$$$$$$$$$$$    Pendaftaran Ulang

T'(n Pe&)rn #$$$$$$$$$$$$$$$$$$$$$$ 

A. DATA SANTRI #

1. Nama Lengkap :__________________________________________________ 

2. Tempat/Tgl. Lhr :__________________________________________________ 3. Jeni !elamin :__________________________________________________ 

". #nak !e :_______________Jumlah Saudara !andung:______________ 

$. Sek%lah &%rmal 'ang Sedang ditempuh :( )*/S+ :___________________________________________________ __ 

( )T/S)P :___________________________________________________ __ 

( S)#/S)! :___________________________________________________ __ 

B. DATA ORANG TUA*WALI SANTRI #

+. Nm A'   :__________________________________________________ 

Umur :________tahun.Peker,aan :__________________________________________________ 

Pendidikan Terakhir :__________________________________________________ 

#lamat :__________________________________________________ :__ 

 ________________________________________________ 

Tlp./-P :__________________________________________________ 

. Nm I(   :__________________________________________________ 

Umur : ________tahun.

Peker,aan :__________________________________________________ Pendidikan Terakhir :__________________________________________________ 

#lamat :__________________________________________________ 

:__________________________________________________ Tlp./-P :__________________________________________________ 

Ungaran )engetahuiPendaftar 0rang Tua/ali Santri

 __________________________ __________________________  Nama Lengkap Tanda Tangan Nama Lengkap Tanda Tangan