formulir_a.2.1
TRANSCRIPT
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PENGAJUAN NPSN BARU
(diisi dengan huruf kapital)
Formulir A11
I.Yang mengajukan
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a. Nama Kepala Sekolah:
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S
I
T
I
J
U
B
A
E
D
A
H
II.Identitas Sekolah
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a. Nama Sekolah:
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P
A
U
D
A
L
B
A
D
A
R
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I
Y
Y
A
H
b. Alamat:
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JL
CURU
G
CILEMBER
KP
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JOGJ
OGAN
RT02RW
02
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c. Jenjang Sekolah
:
TK/A
S!/"#
S"$/"T%
S"A/"A/S"K
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S&'
(. Statu% Sekolah
:
Negeri
S)a%ta
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e. $ropin%i:
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JAWA
BARAT
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*. Kabupaten/Kota:
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BOGOR
g. Kecamatan
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:
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CISARU
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A
h. Kelurahan:
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JO
GJOGA
N
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i. +mail:
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III.Legalitas Sekolah
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a.
No. SK/#,in $en(irian Sekolah:
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04/
ALBAD/2013
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b.Tanggal
:
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15
07
20
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13
c.No. SK/#,in -pera%ional Sekolah :
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421.3/
433DISDIK / 2015
(.Tanggal
:
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27
03
2015
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!alam pengi%ian *ormulir An(a telah men5etujui ketentuan la5anan 5ang berlaku.