FORMULIR PPDB 2015

Please download to get full document.

View again

of 2
23 views
All materials on our website are shared by users. If you have any questions about copyright issues, please report us to resolve them. We are always happy to assist you.

Download

Document Related
Document Description
formulir PPdb
Document Share
Document Transcript
  FORMULIR PENDAFTARANPENERIMAAN PESERTA DIDIK BARU (PPDB) TAHUN PELAJARAN 2015/2016SEKOLAH DASAR NEGERI RANCABENDEM Alamat : Jl. Rancabendem Kel. Sukalaksana Kec. Bungursari Kota Tasikmalaya 46151 A. IDENTITAS CALON PESERTA DIDIK   omor !a tar #diisi ole$ %etugas& : .......................................................................................................1. ama'engka% : .......................................................................................................(. Tem%at dan Tanggal la$ir #sesuai akte kela$iran&: ...............................................................................#tgl)bln)t$n& *. +sia %ada saat %enda taran : ..................ta$un .............................bulan4. Tem%at tinggal calon #alamat& : .......................................................................................................5. Jarak dari tem%at tinggal ke S! yang ditu,u : .......................................Km6. Agama : .......................................................................................................-. Jenis Kelamin : ....................................................................................................... B. IDENTITAS ORANG TUA / WALI CALON PESERTA DIDIK  1. rang Tuaa. Aya$ ama : ......................................................................................................./eker,aan : ....................................................................................................... b. 0bu ama : ......................................................................................................./eker,aan : .......................................................................................................c. Alamat rang TuaJalan : ....................................................................................................... o. Ruma$ : .........................RT : .....................R : ..................!esa2Kelura$an : .......................................................................................................Kecamatan : .......................................................................................................Kabu%aten2Kota : ....................................................................................................... o. Tele%on ruma$23/ rang Tua: .......................................................................................................(. ali /eserta didik #Jika alon /eserta !idik tinggal dengan alia. ama ali : ....................................................................................................... b. /eker,aan ali : .......................................................................................................c. 3ubungan /eserta !idik dgn alid. Alamat aliJalan : ....................................................................................................... o. Ruma$ : .........................RT : .....................R : ..................  !esa2Kelura$an : .......................................................................................................Kecamatan : .......................................................................................................Kabu%aten2Kota : ....................................................................................................... o. Tele%on ruma$23/ ali : ....................................................................................................... C. SEKOLAH DASAR ANG DITUJU !  ama S! #satu %ili$an egeri2Sasta& : .......................................................................................................!iketa$ui2disetu,uirang Tua2ali alon /eserta !idik  .................................................... Tasikmalaya ............. Juni (715alon /eserta !idik #...............................................................& PEMERINTAH KOTA TASIKMALAADINAS PENDIDIKANUPT DINAS PENDIDIKAN WILAAH BARAT SEKOLAH DASAR NEGERI RANCABENDEM Alamat : K%. Rancabendem Kel. Sukalaksana Kec. Bungursari Kota Tasikmalaya /ro8insiJaa Barat Kode /S : 46151 SURAT KETERANGANN # $ ! %21.1/ 6&/ K'.SD /II/201% Ke%ala S! egeri Rancabedem Kota Tasikmalaya dengan ini menyatakan ba$a : ama : A0SA +RJAA3Jenis Kelamin : 'aki)laki 2 /erem%uanTem%at Tanggal 'a$ir : Salatiga 19)*)(774Asal Sekola$ : SD   N'*'$+ K,- +*, 05   !0TR0;A ;en,adi Sisa Kelas 5 S! egeri Rancabendem Kota Tasikmalaya ta$un %ela,aran (714)(715. +ntuk kelancaran administrasi $ara% melengka%i %ersyaratan yakni #'#+$ $-, NISN -,  # $NISN 3 4 .Tasikmalaya 14 Juli (714Ke%ala Sekola$ H.D'' H'$'4 R4+7 S.P  0/.196*7417 19<*75 1 77<  
We Need Your Support
Thank you for visiting our website and your interest in our free products and services. We are nonprofit website to share and download documents. To the running of this website, we need your help to support us.

Thanks to everyone for your continued support.

No, Thanks